Gandhi S K, Hanson M M, Vernava A M, Kaminski D L, Longo W E
Department of Surgery, Section of Colon and Rectal Surgery, St. Louis University School of Medicine, St. Louis, Missouri 63310-0250, USA.
Dis Colon Rectum. 1996 Jan;39(1):88-100. doi: 10.1007/BF02048275.
Ischemic colitis represents the most common form of gastrointestinal ischemia. The presumed etiologies are numerous; however, it typically develops "spontaneously," in the absence of major vasculature occlusion, and in the presence of viable intestine elsewhere. It is most usefully classified into gangrenous and nongangrenous forms, the latter of which may be subdivided into transient and chronic types. Ischemic colitis may develop in people who are otherwise healthy, although a variety of clinical settings, such as shock, predispose to its occurrence. It usually presents as an acute abdominal illness with bloody diarrhea. Diagnosis is confirmed by colonoscopy. Therapy and outcome are dependent on the severity of disease. Nongangrenous colonic ischemia usually requires only medical management and is associated with a good prognosis. The chronic subtype may lead to the sequelae of persistent segmental colitis or colonic strictures, occasionally requiring surgery. Urgent operative intervention and a high morbidity and mortality are the hallmarks of gangrenous colonic ischemia. Special considerations must be given to those patients in whom ischemic colitis develops in the context of colon carcinoma or obstructing colon lesions, after abdominal aortic surgery, and following cardiopulmonary bypass. This review will discuss the clinical spectrum of ischemic colitis.
缺血性结肠炎是胃肠道缺血最常见的形式。其推测病因众多；然而，它通常在没有主要血管闭塞且其他部位肠管存活的情况下“自发”发生。最有用的分类是坏疽型和非坏疽型，后者可再细分为短暂型和慢性型。缺血性结肠炎可发生在原本健康的人群中，尽管多种临床情况，如休克，易引发该病。它通常表现为伴有血性腹泻的急性腹部疾病。结肠镜检查可确诊。治疗和预后取决于疾病的严重程度。非坏疽性结肠缺血通常仅需药物治疗，且预后良好。慢性亚型可能导致持续性节段性结肠炎或结肠狭窄的后遗症，偶尔需要手术治疗。紧急手术干预以及高发病率和死亡率是坏疽性结肠缺血的特征。对于在结肠癌或梗阻性结肠病变背景下、腹主动脉手术后以及体外循环后发生缺血性结肠炎的患者，必须给予特殊考虑。本综述将讨论缺血性结肠炎的临床谱。
