閉塞性結(jié)腸炎6例病例報(bào)告及文獻(xiàn)回顧
發(fā)布時(shí)間：2018-10-19 20:43
【摘要】：背景與目的：閉塞性結(jié)腸炎(Obstructive Colitis)是指出現(xiàn)于結(jié)直腸完全或不完全狹窄性病變(大多為結(jié)直腸惡性腫瘤)口側(cè)的缺血性病變,是一種特殊類型的缺血性腸病。本病發(fā)病率較低,但若在結(jié)直腸腫瘤手術(shù)前或手術(shù)中未仔細(xì)檢查腫瘤病灶口側(cè)的腸道粘膜,在缺血腸段進(jìn)行縫合,則可能會(huì)引起腸瘺等術(shù)后并發(fā)癥。閉塞性結(jié)腸炎這一概念尚未得到我國(guó)臨床醫(yī)生的認(rèn)識(shí)與重視,本文擬通過(guò)病例報(bào)告及文獻(xiàn)回顧對(duì)本病做一介紹。方法：回顧性分析2011年1月-2015年6月期間入住東南大學(xué)附屬中大醫(yī)院患者的結(jié)直腸鏡檢查結(jié)果,篩選出存在結(jié)直腸惡性腫瘤相關(guān)性閉塞性結(jié)腸炎患者,對(duì)其病例資料進(jìn)行分析,并結(jié)合文獻(xiàn)對(duì)本病進(jìn)行全面復(fù)習(xí)。本次研究中閉塞性結(jié)腸炎的診斷標(biāo)準(zhǔn)為：內(nèi)鏡下結(jié)直腸惡性腫瘤口側(cè)粘膜出現(xiàn)缺血性病變,腫瘤與缺血性病變之間存在長(zhǎng)約2-6 cm完全正常的腸道粘膜,且腫瘤肛側(cè)粘膜肉眼上無(wú)明顯異常。結(jié)果：內(nèi)鏡及活檢病理結(jié)果明確診斷為結(jié)直腸惡性腫瘤的患者共463例,其中6例被擬診為結(jié)直腸惡性腫瘤相關(guān)性閉塞性結(jié)腸炎,發(fā)病率為1.3%。6例患者年齡均大于50歲,其中5例為男性,1例為女性,主要癥狀為腹痛、腹瀉、便血。結(jié)腸鏡下均表現(xiàn)為左側(cè)結(jié)腸或直腸的腫瘤性病變(活檢病理示6例均為結(jié)直腸中分化腺癌),內(nèi)鏡下同時(shí)發(fā)現(xiàn)腫瘤口側(cè)的結(jié)腸粘膜可見(jiàn)缺血性病變(充血、水腫、縱行或環(huán)形潰瘍),腫瘤與缺血性病變之間可見(jiàn)長(zhǎng)約2-6cm的正常粘膜。5例患者進(jìn)行了手術(shù)治療,腫瘤病灶及缺血腸段均被切除,圍手術(shù)期及術(shù)后隨訪期間未出現(xiàn)腸瘺及腸梗阻等并發(fā)癥。1例患者明確診斷為結(jié)直腸惡性腫瘤后自動(dòng)出院,失訪。結(jié)論：閉塞性結(jié)腸炎為一種特殊類型的缺血性腸病,多繼發(fā)于結(jié)直腸惡性腫瘤。結(jié)腸鏡及活檢病理檢查是該病的確診手段,提高對(duì)該病的認(rèn)識(shí),盡可能在術(shù)前或術(shù)中做出診斷,避免在缺血腸段進(jìn)行縫合,會(huì)有助于減少腸瘺、腹膜炎等手術(shù)并發(fā)癥,提高患者術(shù)后生存質(zhì)量。
[Abstract]:Background & objective: (Obstructive Colitis) is a special type of ischemic bowel disease which occurs in the oral side of colorectal complete or incomplete stenosis (mostly colorectal malignant tumor). The incidence of this disease is relatively low, but if the intestinal mucosa of the Kitchen side of the tumor is not carefully examined before or during the operation, and the intestinal ischemia segment is sutured, it may cause postoperative complications such as intestinal fistula. The concept of obliterate colitis has not been recognized and paid much attention by Chinese clinicians. This article introduces the disease by case report and literature review. Methods: from January 2011 to June 2015, the results of colonoscopy of patients admitted to the affiliated Chinese University Hospital of Southeast University were retrospectively analyzed, and the patients with colorectal malignant tumor-associated obliterate colitis were screened out, and the data of the cases were analyzed. Combined with the literature review of the disease. In this study, the diagnostic criteria of obliterate colitis were as follows: there were ischemic lesions in the oral mucosa of colorectal malignant tumors under endoscope, and there was a completely normal intestinal mucosa with a length of 2 to 6 cm between the tumor and the ischemic lesion. There was no obvious abnormality in the anal mucosa of the tumor. Results: there were 463 cases of colorectal malignant tumor diagnosed by endoscopy and biopsy, 6 of them were diagnosed as colorectal malignant tumor-associated obliterative colitis, the incidence rate was 1.3.6 cases, all of them were over 50 years old. Among them, 5 cases were male and 1 case female. The main symptoms were abdominal pain, diarrhea and bloody stool. Under colonoscopy, tumor lesions were found in the left colon or rectum (biopsy and pathology showed that all 6 cases were middle differentiated adenocarcinoma of the rectum), and ischemic lesions (hyperemia, edema) were also found in the mucous membrane of the colon on the oral side of the tumor under endoscopy. Longitudinal or circular ulcers), the normal mucous membrane with long 2-6cm was seen between tumor and ischemic lesion. 5 patients were treated surgically. The tumor focus and ischemic intestinal segment were excised. There were no complications such as intestinal fistula and intestinal obstruction during perioperative period and postoperative follow-up. Conclusion: obliterated colitis is a special type of ischemic bowel disease, which is secondary to colorectal malignant tumor. Colonoscopy and biopsy and pathological examination are the means of diagnosis of the disease. To improve the understanding of the disease, to make the diagnosis before or during the operation as far as possible and to avoid suture in the ischemic intestinal segment will help to reduce the complications such as intestinal fistula, peritonitis and other surgical complications. To improve the quality of life after operation.
【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R574.62
本文編號(hào)：2282310
[Abstract]:Background & objective: (Obstructive Colitis) is a special type of ischemic bowel disease which occurs in the oral side of colorectal complete or incomplete stenosis (mostly colorectal malignant tumor). The incidence of this disease is relatively low, but if the intestinal mucosa of the Kitchen side of the tumor is not carefully examined before or during the operation, and the intestinal ischemia segment is sutured, it may cause postoperative complications such as intestinal fistula. The concept of obliterate colitis has not been recognized and paid much attention by Chinese clinicians. This article introduces the disease by case report and literature review. Methods: from January 2011 to June 2015, the results of colonoscopy of patients admitted to the affiliated Chinese University Hospital of Southeast University were retrospectively analyzed, and the patients with colorectal malignant tumor-associated obliterate colitis were screened out, and the data of the cases were analyzed. Combined with the literature review of the disease. In this study, the diagnostic criteria of obliterate colitis were as follows: there were ischemic lesions in the oral mucosa of colorectal malignant tumors under endoscope, and there was a completely normal intestinal mucosa with a length of 2 to 6 cm between the tumor and the ischemic lesion. There was no obvious abnormality in the anal mucosa of the tumor. Results: there were 463 cases of colorectal malignant tumor diagnosed by endoscopy and biopsy, 6 of them were diagnosed as colorectal malignant tumor-associated obliterative colitis, the incidence rate was 1.3.6 cases, all of them were over 50 years old. Among them, 5 cases were male and 1 case female. The main symptoms were abdominal pain, diarrhea and bloody stool. Under colonoscopy, tumor lesions were found in the left colon or rectum (biopsy and pathology showed that all 6 cases were middle differentiated adenocarcinoma of the rectum), and ischemic lesions (hyperemia, edema) were also found in the mucous membrane of the colon on the oral side of the tumor under endoscopy. Longitudinal or circular ulcers), the normal mucous membrane with long 2-6cm was seen between tumor and ischemic lesion. 5 patients were treated surgically. The tumor focus and ischemic intestinal segment were excised. There were no complications such as intestinal fistula and intestinal obstruction during perioperative period and postoperative follow-up. Conclusion: obliterated colitis is a special type of ischemic bowel disease, which is secondary to colorectal malignant tumor. Colonoscopy and biopsy and pathological examination are the means of diagnosis of the disease. To improve the understanding of the disease, to make the diagnosis before or during the operation as far as possible and to avoid suture in the ischemic intestinal segment will help to reduce the complications such as intestinal fistula, peritonitis and other surgical complications. To improve the quality of life after operation.
【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R574.62
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 梁礦立;袁吉欣;;腸結(jié)核的影像學(xué)診斷分析[J];中國(guó)現(xiàn)代醫(yī)藥雜志;2011年08期
，本文編號(hào)：2282310
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