CAJ | 학술논문

目的探讨缺血性结肠炎(IC)的内镜表现和病理特征,以引起临床医师对该病的重视,减少漏诊和误诊.方法对南京大学医学院附属鼓楼医院内镜中心2005年5月至2008年3月85例IC患者进行回顾性分析.所有患者均在发病2周内行结肠镜检查和病理活检.结果 85例IC患者临床主要表现为腹痛、腹泻和便血、可伴有低热等.结肠镜下所见病变主要在左半结肠(80%,68/85).85例IC患者中非坏疽型82例和坏疽型3例.非坏疽型中一过性IC内镜表现为点状出血,黏膜水肿、发脆.节段性红斑,散在糜烂和纵行溃疡,病变与正常黏膜分界清楚.非可逆性IC内镜表现为黏膜发紫或发黑、伪性、假息肉及假性肿瘤,其中狭窄性IC内镜表现为全壁增厚、肠腔狭窄及结肠袋消失.坏疽型IC内镜表现为黏膜发紫和假息肉形成.IC病理特征为黏膜组织炎症伴糜烂和肉芽组织增生、腺体萎缩、固有层出血,特别是黏膜下层见含铁血黄素沉着的巨噬细胞.结论尽管IC内镜及病理改变缺乏特异性,但早期行结肠镜检是诊断IC的重要方法,有助于临床医师提高对IC的诊治,减少误诊.
목적 탐토결혈성결장염(IC)적내경표현화병리특정,이인기림상의사대해병적중시,감소루진화오진.방법 대남경대학의학원부속고루의원내경중심2005년5월지2008년3월85례IC환자진행회고성분석.소유환자균재발병2주내행결장경검사화병리활검.결과 85례IC환자림상주요표현위복통、복사화편혈、가반유저열등.결장경하소견병변주요재좌반결장(80%,68/85).85례IC환자중비배저형82례화배저형3례.비배저형중일과성IC내경표현위점상출혈,점막수종、발취.절단성홍반,산재미란화종행궤양,병변여정상점막분계청초.비가역성IC내경표현위점막발자혹발흑、위성、가식육급가성종류,기중협착성IC내경표현위전벽증후、장강협착급결장대소실.배저형IC내경표현위점막발자화가식육형성.IC병리특정위점막조직염증반미란화육아조직증생、선체위축、고유층출혈,특별시점막하층견함철혈황소침착적거서세포.결론 진관IC내경급병리개변결핍특이성,단조기행결장경검시진단IC적중요방법,유조우림상의사제고대IC적진치,감소오진.
Objective To evaluate the endoscopic findings and clinicopathologic characteristics of ischemic colitis in order to avoid misdiagnosis.Methods Eighty five patients with ischemic colitis who underwent endosopy within two weeks of onset of the symptom in center of Gulou hospital from Mar. 2005 to Apr.2008 were retrospectively reviewed for their endoscopic findings and clinicopathologic characteristics.All biopsy specimens were pathologically examined with HE and observed under light microscopy. Results The common features of 85 patients included abdominal pain,diarrhea or bloody diarrhea and hematochezia.The lesions were mainly located at left colon with segmental form(80%,68/85).Of 85 patients,non-gangraenous type was found in 82 and gangrenous type in 3.Endoscopic visualization of transient ischemic colitis included petechial hemorrhages,edematous and fragile mucosa,segmental erythema,scattered erosion,longitudinal ulcerations,and sharply defined segment of involvement.Stricture ischemic colitis was characterized by full-thickness mucosa,1umens stricture and haustrations disappeared.The characteristics of gangrenous colitis was cyanotic and pseudopolyps. Clinicoplathological examination revealed mucosal inflammation accompanied by erosion,granulation tissue hyperplasia and gland atrophy,lamina propria hemorrhage,especially maerophages with hemosiderin pigmentation in submucosa. Conclusions Although there is no specific changes in endoscopic findings and clinicopathologic characteristics,but early colonoscopy plays an important role in diagnosis of ischemic colitis,which is helpfull in management of ischemic colitis and reducing the misdiagnosis.