临床外科杂志 ›› 2021, Vol. 29 ›› Issue (5): 458-461.doi: 10.3969/j.issn.1005-6483.2021.05.017

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缺血性结肠炎重症误诊分析

  

  1. 116000 辽宁大连,解放军第九六七医院普外科
  • 出版日期:2021-05-20 发布日期:2021-05-20
  • 通讯作者: 焦战,Email:drjiao@126.com

Misdiagnosis of severe ischemic colitis

  1. Department of General Surgery,Chinese People Liberation Army 967 Hospital,Dalian 116000,China
  • Online:2021-05-20 Published:2021-05-20

摘要: 目的  对缺血性结肠炎(IC)的临床表现及诊治过程进行探讨,分析误诊因素。
方法  对2017年1月至2019年9月间17例IC病人临床表现特点,诊疗过程进行分析。除2例腹膜炎病人未行肠镜检查,行外科手术治疗外,其余病情较平稳者均早期肠镜检查明确诊断。15例行抗炎、控制饮食、改善循环、抗凝、补液等治疗后康复;另2例出现腹膜炎行手术治疗,其中1例术中见升结肠已缺血坏死行右半结肠切除手术治疗,术后顺利康复;另1例病人术中见肠血运不良、散在点状浆膜坏死灶,家属拒绝行肠切除,行腹腔引流,术后药物治疗,腹膜炎逐渐消失,康复出院。
结果  本组病人均为中老年,女性多于男性,多数伴有糖尿病、高血压、冠心病、血液系统疾病等基础疾病。本组病人均康复出院,平均住院2周,随访中除2例慢性病人再次发病,其余药物预防后未见复发。
结论  对于中老年,特别伴有基础疾病的病人,出现腹痛、腹泻、便血应警惕IC的可能,病情较稳定者应早期行肠镜检查明确,但病情重出现腹膜炎的病人误诊率较高,对考虑有肠坏死、穿孔的病人应早期手术治疗,才能降低死亡率。

关键词: 缺血性结肠炎, 结肠镜, 误诊, 手术

Abstract: Objective To investigate the clinical manifestations, diagnosis and treatment of ischemic colitis (IC), and to analyze the misdiagnosis factors.
Method From January 2017 to September 2019,17 IC patients were reported and analyzed for their clinical features and diagnosis and treatment process.Except for 2 patients with peritonitis who did not undergo colonoscopy and underwent surgical operation,all the others whose condition was stable were diagnosed by early colonoscopy.15 patients were treated with anti-inflammatory,diet control,circulatory improvement,anticoagulation and fluid supplementation.The other 2 patients with peritonitis received surgical treatment,1 of whom underwent resection of the right half colon due to intestinal necrosis and recovered successfully after opration;Another patient was found with poor intestinal blood supply and scattered serous membrane necrosis during the operation.The family member refused to undergo intestinal resection and received abdominal drainage.The patient recovered with postoperative drug therapy.
Results All patients were middle-aged and elderly,more female than male,most of them were with diabetes,hypertension,coronary heart disease,hematological system diseases and other underlying diseases.All  patients had recovered and been released from hospital,with an average of two weeks in hospital.In the follow-up,except for 2 chronic patients,recurrence was not observed in the rest of the drug prevention.
Conclusion The middle-aged and the elderly,especially with the underlying diseases,should be vigilant the IC,if the abdominal pain,diarrhea,blood in the stool were appeared,and stable patients should be diagnosed early by colonoscopy.However,for patients with recurrent peritonitis,the rate of misdiagnosis is high,and early surgical treatment should be taken to patient with intestinal necrosis and perforation to reduce the mortality rate.

Key words: ischemic colitis, coloscope, misdiagnose, operation

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