缺血性结肠炎与溃疡性结肠炎临床诊断对比分析

摘要

目的：对比分析缺血性结肠炎及溃疡性结肠炎临床特点与组织病理学的差异，为临床鉴别诊断提供依据。方法收集广西医科大学第一附属医院2010~2013年20例缺血性结肠炎及30例溃疡性结肠炎患者性别、病程、年龄、基础疾病史、临床表现，肠镜结果及病理特点等资料，并进行对比分析。结果缺血性结肠炎发病以60岁以上老年人为主，起病急，病程短，多伴有高血压、糖尿病等基础疾病，溃疡性结肠炎以中青年患者为主，病程长，伴随基础疾病较少见，前者临床表现以腹胀、呕吐多见，后者以黏液血便及里急后重症状较多见。缺血性结肠炎肠镜下病变较少累及直肠，多出现黏膜水肿，溃疡多呈纵行，溃疡性结肠炎常累及直肠，常合并炎性假息肉，溃疡以地图状为主，病变部位呈连续性。病理上，缺血性结肠炎以血管扩张充血、间质水肿及血管壁增厚多见，而炎性细胞浸润及隐窝脓肿较少见。结论结合年龄、既往病史、临床症状及内镜、组织病理学检查结果，有助于缺血性结肠炎与溃疡性结肠炎的鉴别诊断。%Objective To compare the differences of clinical and histopathologic features between ischemic colitis and ulcerative colitis,which can provide the basis for the diagnosis and helpful for treatment.Methods Clinical data of 20 cases patients with ischemic colitis (IC)and 30 cases patients with ulcerative colitis (UC)from 2010 to 2014 in the First Affilia-ted Hospital of Guangxi Medical University were retrospective analyzed,the differences of gender,age,course of disease, disease history,clinical manifestation,colonoscopy findings,and pathological feature of the two groups were compared. Result The patients with IC was more prevalent in people over 60 years old,rapid onset,short duration and often associated with hypertension,diabetes and other basic diseases,while patients with UC mainly in young people,long course of dis-ease,with the basis of disease was rare;The clinical manifestations of IC mainly abdominal distension and vomiting,While mucous bloody stool and tenesmus were more common in patients with UC.Under colonoscopy,IC endoscopic lesions less involved rectum,often appear mucosal edema,a longitudinal ulcer.UC was often implicates rectum,accompanied with in-flammatory pseudo-polyps,ulcer showed a map like, pathological changes were continuously.In pathological aspects, vascular dilatation and congestion,interstitial edema and vessel wall thickening were usually presented in IC,the inflamma-tory cell infiltration and crypt abscess was rare in IC.Conclusion Integrated analysis of age,previous medical history,clini-cal symptoms and endoscopic,histopathological examination findings would be helpful for differential diagnosis of IC and UC.