Fanti L, Masci E, Mariani A, Chiesa R, Jannello A, Melissano G, Castellano R, Guerini S, Tittobello A
Gastrointestinal Unit, San Raffaele Hospital, University of Milan, Italy.
Ital J Gastroenterol Hepatol. 1997 Aug;29(4):357-60.
Ischaemic colitis is an infrequent, but potentially fatal, complication of abdominal aortic surgery. Its presentation is often underestimated on account of a paucity of symptoms, thus the real incidence of ischaemic colitis may be higher.
To determine the prognostic value and sensitivity of endoscopy, early postoperative endoscopic findings were evaluated.
Over a period of three years a prospective study was undertaken in a consecutive series of 105 patients (mean age 68.9 years, range 51-85) undergoing routine rectosigmoidoscopy within 72 hours of aortic reconstructive surgery.
Colonic ischaemia was found in 12 patients (11.4%); five had endoscopic evidence of mild ischaemic colitis, ulcerations were identified in five and diffuse superficial necrosis in two. Seven of the 12 patients were symptomatic. Laparotomy was never deemed necessary and all patients were successfully treated with a conservative regimen. There were no deaths. Elective reconstruction or urgent procedure did not correlate with the development of colonic ischaemia, nor did duration of aortic cross-clamp time, patency of the inferior mesenteric artery and its possible ligation or reimplantation or patency of the hypogastric arteries.
Rectosigmoidoscopy is effective for early diagnosis of ischaemic colitis. Early endoscopy should be routinely performed only for patients in whom impaired blood flow is suspected on the basis of the intraoperative objective assessment of the colon and in presence of symptoms.
缺血性结肠炎是腹主动脉手术中一种少见但可能致命的并发症。由于症状较少，其表现常被低估，因此缺血性结肠炎的实际发病率可能更高。
为了确定内镜检查的预后价值和敏感性，对术后早期内镜检查结果进行了评估。
在三年的时间里，对连续105例（平均年龄68.9岁，范围51 - 85岁）在主动脉重建手术后72小时内接受常规直肠乙状结肠镜检查的患者进行了前瞻性研究。
12例患者（11.4%）发现结肠缺血；5例有轻度缺血性结肠炎的内镜证据，5例发现溃疡，2例发现弥漫性浅表坏死。12例患者中有7例有症状。从未认为有必要进行剖腹手术，所有患者均采用保守治疗方案成功治疗。无死亡病例。择期重建或急诊手术与结肠缺血的发生无关，主动脉阻断时间、肠系膜下动脉通畅情况及其可能的结扎或再植、或髂内动脉通畅情况也与结肠缺血的发生无关。
直肠乙状结肠镜检查对缺血性结肠炎的早期诊断有效。仅对那些根据术中对结肠的客观评估怀疑血流受损且有症状的患者应常规进行早期内镜检查。
