CAJ | 학술논문

目的:研究缺血性结肠炎(ischemic colitis,IC)与溃疡性结肠炎(ulcerative colitis,UC)临床及组织病理学的差异,有助两者的鉴别诊断,利于临床治疗.方法:收集20例IC和30例UC患者,对其临床及组织病理学等资料进行对比分析.结果:IC组发病时间[(5±7)d]明显较UC组发病时间[(953±1354)d]短.IC组中65%的患者伴有高血压、冠状动脉性心脏病、心房颤动、房性早搏、腹部手术史等疾病史中的一项或几项,明显高于UC组的20%;IC组以急性发病、腹痛(85%)、血便(60%)及腹泻(50%)多见,而UC且以腹痛(83%)、腹泻(63%)、黏液脓血便(57%)及里急后重(20%)为主要临床表现;在内镜表现方面,IC多以沿肠系膜侧分布的纵形溃疡为主(60%),且病变多仅累及肠腔的1/4～1/2周(80%),呈节段性分布(60%),与邻近正常黏膜分界清楚(75%),而UC则以弥漫性地图状溃疡为主(43%),病变多累及肠腔全周(90%),炎性息肉明显多见(37%).在组织病理学方面,血管扩张充血(90%)、间质严重水肿(95%)在IC中多见,血管壁增厚(50%)是其特征性表现,隐窝脓肿(47%)则在UC中多见.两组以上差异均有统计学意义(P<0.05).结论:组织病理学特点、肠镜下表现以及患者临床特征的差异,为IC和UC的鉴别提供了有力依据.
목적:연구결혈성결장염(ischemic colitis,IC)여궤양성결장염(ulcerative colitis,UC)림상급조직병이학적차이,유조량자적감별진단,리우림상치료.방법:수집20례IC화30례UC환자,대기림상급조직병이학등자료진행대비분석.결과:IC조발병시간[(5±7)d]명현교UC조발병시간[(953±1354)d]단.IC조중65%적환자반유고혈압、관상동맥성심장병、심방전동、방성조박、복부수술사등질병사중적일항혹궤항,명현고우UC조적20%;IC조이급성발병、복통(85%)、혈편(60%)급복사(50%)다견,이UC차이복통(83%)、복사(63%)、점액농혈편(57%)급리급후중(20%)위주요림상표현;재내경표현방면,IC다이연장계막측분포적종형궤양위주(60%),차병변다부루급장강적1/4～1/2주(80%),정절단성분포(60%),여린근정상점막분계청초(75%),이UC칙이미만성지도상궤양위주(43%),병변다루급장강전주(90%),염성식육명현다견(37%).재조직병이학방면,혈관확장충혈(90%)、간질엄중수종(95%)재IC중다견,혈관벽증후(50%)시기특정성표현,은와농종(47%)칙재UC중다견.량조이상차이균유통계학의의(P<0.05).결론:조직병이학특점、장경하표현이급환자림상특정적차이,위IC화UC적감별제공료유력의거.
Objective To study the differences of clinical and histopathologic features between ischemic colitis (IC) and ulcerative colitis (UC), which can make for the differential diagnosis and treatments. Methods Comparative analysis were focused on the clinical and histopathologic data of IC patients (20 cases) and UC patients (30 eases). Results The onset duration of IC [(5±7) d] was significantly shorter than that of UC [(953±1354) d]. IC patients tended to have history of cadiovascular diseases or abdominal surgery (65%). The typical clinical manifestations of IC were sudden onset of abdominal pain (85%), hematochezia (60%)and diarrhea (50%), but UC usually presented with abdominal pain (83%), diarrhea (63%), bloody mucopurulent stool (57%) and tenesmus (20%). Colonoscopy showed longitudinal ulceration (60%)on the mesenteric side, the segmental lesions usually involved only 1/4-1/2 of the perimeter of the lumen (80%), and the boundary of lesions was clear (75%) in IC patients. On the contrary, the ulcer of UC was usually map-like (43%), the lesions usually involved the entire lumen (90%), and the pseudopolyp (37%) was another colonoscopic feature of UC. The histopathologic study revealed that dilation and hyperaemia of vessels (90%) were common in IC. Severe edema of mucosa (95%) was usually presented in IC, and the thickened vascular wall (50%) was the histopathologic characteristic of IC.Crypt abscesses (47%) usually appeared in UC. Conclusions The histopathologic characteristics and differences of colonoscopic findings and clinical features provide strong bases for the differentialdiagnosis between IC and UC.