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目的:分析缺血性结肠炎(IC)的临床、内镜表现与病理特征,探讨结肠镜和病理检查对IC的诊断价值。方法:42例IC患者,均在入院后72h内行结肠镜检查和病理活检,回顾性分析患者的临床、内镜表现及病理特征。结果:本组患者年龄>50岁36例(85.71%),临床表现主要为突发腹痛、腹泻及便血。内镜检查结果显示一过型IC36例(病变呈纵行溃疡者16例,病变呈环形侵及肠腔全周者10例,病变呈散在点状红斑者6例),内镜特点为黏膜充血水肿、糜烂并可见溃疡,病变处与正常黏膜界限清楚。狭窄型IC6例,内镜特点为肠腔明显狭窄、全壁增厚及结肠袋消失。病变部位多位于左半结肠;IC病理特征为黏膜活组织水肿,中性粒细胞浸润,固有层纤维结缔组织增生、出血及小血管内纤维素样血栓及巨噬细胞内有含铁血黄素沉积。结论:中老年人突发腹痛、腹泻及便血时应警惕缺血性结肠炎,内镜结合病理检查是明确诊断及了解病变程度及预后的主要方法。
Objective: To analyze the clinical, endoscopic and pathological features of ischemic colitis (IC) and to explore the value of colonoscopy and pathological examination in the diagnosis of IC. Methods: Forty-two IC patients underwent colonoscopy and biopsy within 72 hours after admission. The clinical, endoscopic and pathological features of the patients were retrospectively analyzed. Results: Thirty-six patients (85.71%) were aged> 50 years old. The main clinical manifestations were sudden abdominal pain, diarrhea and hematochezia. Endoscopic examination showed that one-off IC36 cases (lesions were longitudinal ulcers in 16 cases, the lesions were ring-shaped invasion and intestinal lumen in 10 cases, the lesions were dotted erythema in 6 cases), the endoscopic features of mucosal congestion Edema, erosion and visible ulcers, lesions and normal mucosal boundaries clear. Narrow IC6 cases, endoscopic features of the obvious narrow intestine, wall thickening and colon bags disappear. Lesions are located in the left colon; IC pathological features of mucosal tissue edema, neutrophil infiltration, lamina propria fibrous connective tissue hyperplasia, hemorrhage and small blood vessels of cellulose-like thrombus and macrophage hemosiderin deposition . Conclusion: Middle-aged and elderly patients with abdominal pain, diarrhea and blood in the stool should be alert to ischemic colitis, endoscopy combined with pathological examination is a clear diagnosis and understanding of the main pathological changes and prognosis.