慢性放射性肠炎并发肠梗阻的治疗

目的:探讨慢性放射性肠炎并发肠梗阻的治疗方法及疗效.方法:回顾分析21例慢性放射性肠炎并发肠梗阻的临床资料,对其进行总结.结果:7例保守治疗的病例中有5例复发,治愈率仅(28.6%,2/7),保守治疗效果不佳.14例手术患者总体疗效满意.10例行肠切除吻合术的患者,治愈率达(90.0%,9/10),可见手术治疗为慢性放射性肠炎并发肠梗阻的最佳方法.1例出现吻合口瘘的患者,再次手术证实为第1次手术切除肠管过少,残留病变肠管所致.结论:慢性放射性肠炎并发肠梗阻的最佳治疗方法为手术治疗,手术方式应尽量行肠切除一期吻合术,手术时应尽量切除全部病变肠管,避免出现吻合口瘘.同时肠造口术或旁路手术也是必要术式,应根据具体情况选择.     

1例儿童肠套叠误诊的原因分析

肠梗阻是一种常见的外科急腹症之一，复杂多变，病情危重。肠套叠属绞窄性肠梗阻中的一型，约占各类肠梗阻的4％。是一段肠管套入其邻近的肠管内所致。临床表现以腹痛，血便和腹部包块为三大特征。现将笔者遇到的1例肠套叠病例报告如下。     

腹会阴联合直肠癌根治术术后并发早期肠梗阻的病因分析及防治

目的探讨腹会阴联合直肠癌根治术术后并发早期肠梗阻的病因及防治方法。方法回顾性分析因低位直肠癌行腹会阴联合直肠癌根治术术后并发早期肠梗阻的18例患者的临床资料。结果 18例术后并发早期肠梗阻患者中,麻痹性肠梗阻6例,粘连性肠梗阻5例,盆底腹膜内疝3例,乙状结肠造瘘肠管与侧腹壁间隙内疝2例,乙状结肠造瘘肠管扭转1例,造瘘口狭窄1例,其中3例发展为绞窄性肠梗阻。6例麻痹性肠梗阻、1例造瘘口狭窄及4例粘连性肠梗阻经保守治疗痊愈,7例手术患者,根据术中情况,分别行内疝复位术、绞窄肠段切除吻合、重新缝闭盆底腹膜及侧腹壁裂隙、肠粘连松解+肠排列术、乙状结肠造瘘肠管扭转复位术并再行乙状结肠造瘘术。18例均痊愈出院。结论腹会阴联合直肠癌根治术术后并发肠梗阻原因复杂,具体治疗应依据病因进行个体化处理。     

肠结核并发肠梗阻再次手术的临床分析（附12例报告）

回顾性分析河南省郑州市第六人民医院2013年12月至2016年8月收治的肠结核并发肠梗阻,进行二次手术治疗的12例患者的临床资料。12例患者中,男7例,女5例,年龄16～63岁,中位年龄32岁;均在术中或术后病理检查证实为肠结核。12例患者再次手术的原因及术式包括：发生完全性肠梗阻6例,其中行开腹肠粘连松解术4例,肠管部分切除一期吻合术2例;发生腹腔或盆腔脓肿无局限倾向而引起腹膜炎2例,均行开腹脓肿清除、腹腔引流术;出现肠穿孔4例,其中行肠管切除一期吻合术3例,腹壁双口造瘘、机体好转后行二期手术1例。12例患者术后均给予规范的抗结核药物治疗,随访6个月均未再次出现肠梗阻。笔者认为,选择合理的手术方式及手术前后正规的抗结核药物治疗是治愈结核性肠梗阻的关键。     

生长激素抑制素治疗肠梗阻

【《医学世界报导》1986年4月】根据美国溃疡研究和教育中心对动物的实验性肠梗阻的观察,发现生长激素抑制素(Somatostatin)这种神经肽能抑制梗阻的肠管分泌钠、钾和水,并能防止肠管膨胀、紫绀和坏死,从而提出生长激素抑制素可作为肠梗阻术前的一种有效的辅助疗法,而且对不需手术治疗的不完全     

超细胃镜引导下放置经鼻肠梗阻导管治疗肠梗阻26例

肠梗阻患者留置肠梗阻导管,比普通胃管更能有效地吸引肠内容物,降低肠管内压力,减轻水肿,恢复肠道血运及肠管动力,从而达到非手术解决肠梗阻的目的。临床上放置肠梗阻导管的方法很多,我院自2009年起采用超细胃镜引导下放置经鼻肠梗阻导管减压治疗肠梗阻,疗效满意,报道如下。     

腹腔镜技术在急性肠梗阻治疗中的应用

目的　探讨腹腔镜技术在急性肠梗阻治疗中的应用价值。方法　采用电视腹腔镜设备与器械为３２ 例急性肠梗阻患者实施了腹腔镜手术治疗。结果　腹腔镜手术３０ 例（腹腔镜肠粘连松解术２２例,腹腔镜小肠扭转复位术６ 例,腹腔镜辅助乙状结肠切除术２ 例）,术中肠管损伤２ 例,均于腹腔镜下修补成功。因粘连严重与腹膜后脂肪肉瘤中转开腹手术２例。术后均恢复顺利,无手术并发症。腹腔恶性肿瘤漏诊２ 例,经再次开腹手术切除。结论　腹腔镜急性肠梗阻手术具有微创外科的优点,可以部分代替开腹手术治疗机械性肠梗阻,但对腹膜间位或后位脏器病变的观察与严重粘连病例的治疗有一定的局限性。     

双腔气囊肛門減压管

在肠梗阻的手术治疗过程中,常因肠管极度膨胀,致使手术野暴露不佳、操作不便、易使肠壁受损或肠系膜撕裂出血,且在腹壁切口缝合时,因肠管膨胀,张力过大而感到极为困难;为克服上述种种困难,在手术中手术者多采取肠腔切开或利用特制套管针进行肠减压术。但在实际工作中我们体会到以上两种处理方法有很多缺点:     

肠梗阻保守治疗的护理

肠梗阻是指肠内容物不能顺利通过肠腔，是外科常见的急腹症。保守治疗是每一个肠梗阻病人必须首先采用的方法，部分单纯性肠梗阻病人，常可采用此法使症状完全解除而免于手术，对需要手术的病人，此法也是手术前必不可少的治疗措施，有效地胃肠减压是保守治疗成功与否的关键。     

B超诊断肠梗阻的分析

目的分析肠梗阻超声图象的特征，提高诊断率．方法使用阿洛卡630型超声诊断仪、探头频率3．5MHz，全部病例为直接扫查法，患者行仰卧位，全腹扫查，为避免肠气干扰，适当加压探头，并经腹部两侧进行扫查，观察肠袢有无扩张，肠腔内积液及肠袢蠕动的情况．结果肠管扩张，小肠直径在3．2cm～4．3cm之间，肠管积气积液为形态不定的强回声光团，其后方逐次衰减，积液显示为无回声浪性暗区，内有浮动的强回声光点，可见液体无回声及气体点状回声的游动和往返流动，肠壁显示清楚，厚度为0．8cm，其中1例扩张肠管横切呈“同心圆征”强弱交错排列的环带，纵切呈“套筒征”．结论肠梗阻可由多个不同原因引起，其特点是肠内容物不能顺利通过肠道，造成了一系列的病理变化及图象特征性改变，梗阻发生后，肠腔内吸收液体减少或不吸收，使肠道积液，超声正好利用液体造声特点，清晰显示肠管有无扩张，肠壁变化，肠蠕动及肠内容物在肠管内游动现象，为肠梗阻做出诊断．肠管扩张严重处多认为梗阻部位．B超还是诊断肠梗阻的一种较好的诊断方法．     

Patterns of Treatment of Gallstone Ileus over a 45-Year Period

All patients with gallstone ileus admitted to our institutions between 1938 and 1982 were retrospectively analyzed by grouping the patients into 10-year periods. Forty-five patients were studied, of whom 39 required operation. When hospital statistics for admissions, length of stay, and mortality rates from the Mount Sinai Hospital were compared to the gallstone ileus data, it was found that there has been no significant change in the admission rate for these patients. The mortality rate and length of stay of gallstone ileus patients has also remained constant over the past 25 years despite the general hospital decrease in both of these numbers. There has been no change in the complication rate, duration of symptoms prior to admission, or the preoperative diagnostic rate of gallstone ileus during the duration of this study.     

Postoperative gastric ileus

Gastric emptying was measured in healthy, trained, unanesthetized dogs before and after surgical manipulation of the intestine and/or treatment with bretylium. Gastric content was found to decline exponentially with time. The pattern of emptying could be defined by the volume remaining in the stomach 10 minutes after the start of feeding and by the slope of the exponential decline in volume of the contents (the rate of gastric emptying). Laparotomy with intestinal manipulation induced gastric retention, but laparotomy alone (sham operation) did not change the rate of gastric emptying. Bretylium, an adrenergic blocking drug, suppressed the postoperative gastric ileus without significantly altering gastric emptying in control animals. Our observations support the classical assumption of a sympathetic hyperactivity during postoperative ileus and suggest that adrenergic blocking agents may be useful in the treatment of paralytic ileus.The information reported herein was previously presented to the Third International Symposium on Gastrointestinal Motility, Stockholm. Sweden, 1971.     

Successful surgical treatment of peritoneal dissemination of hepatocellular carcinoma

Hepatocellular carcinoma rarely disseminates intraperitoneally. When it does, it usually is considered a terminal event. The successful treatment of complications of peritoneal metastases by surgical resection in a patient with hepatocellular carcinoma is reported. A 63-year-old man with hepatocellular carcinoma in the anterior segment underwent transarterial and portal embolization followed by extended radical hepatectomy. Five years and 8 months later, he presented with an ileus that was secondary to multiple peritoneal metastases that were resected to the extent possible. Eight months later, the patient presented with a second episode of ileus and underwent another operation that included bowel resection. However, pelvic tumors that were unresectable also were present. The patient survived for another 9 months before dying with peritoneal carcinomatosis. Although surgical treatment of peritoneal dissemination of hepatocellular carcinoma is not curative, surgery may improve survival and provide a good quality of life in selected cases.     

Postoperative motility of the large intestine in man.

Motor activity of the colon in the immediate postoperative period has been studied in human subjects using radiotelemetering capsules, radioopaque markers and serial abdominal radiographs. Following operations outside the abdomen there is a delay of about 16 hours before colonic activity returns. After abdominal operations the delay is from 40 to 48 hours. The length of an operation has no significant effect upon the duration of colonic ileus. The amount of postoperative analgesia has no significant effect upon the duration of colonic ileus. Gaseous distension after laparotomy is confined to the colon.     

Somatostatin as adjuvant therapy in the management of obstructive ileus

The adjuvant use of somatostatin in the clinical management of obstructive ileus was studied prospectively. Fifty-four consecutive patients suffering from total obstructive ileus were managed over a period of one year. A double-blind clinical trial involving the administration of somatostatin for two days was carried out. Twenty-seven non-selected patients received somatostatin, while the other twenty-seven did not. Of the 27 patients who did not receive somatostatin, 12 (44%) were operated on, while only 6 (22%) of those who had received the agent required surgery. As little as 16% of the patients who received somatostatin pre-operatively exhibited severe dilatation and necrosis of the intestine proximal to the area of destruction as compared with 83% of those patients who did not receive somatostatin before the operation. It was concluded that while the administration of somatostatin to patients suffering from obstructive ileus may not be directly related to a reduction in surgery, it does reduce the effects of intestinal dilatation on the healthy gut proximal to the area of destruction.     

Gastrointestinal peptide hormones during postoperative ileus

The hypothesis was that postoperative ileus might be caused by a disturbed balance between the motor-stimulating hormones, motilin and substance P, and the motorinhibitory hormone, vasoactive intestinal polypeptide, and that octreotide might prevent this disturbance and so ameliorate the ileus. In 15 conscious dogs with chronic gastro-intestinal electrodes, electrical activity was recorded and blood was drawn for radioimmunoassay of motilin, substance P, and vasoactive intestinal peptide (VIP) during fasting and after a liquid meal. Ileus was then induced by celiotomy and intestinal abrasion. During and after operation, five dogs received 154 mM NaCl only, five dogs octreotide, 0.19 µg/kg/hr, and five octreotide, 0.83 µg/kg/hr. Plasma levels of motilin, substance P, and VIP were changed little by operation, but cyclical increases in plasma motilin, which occurred preoperatively during phase III of the interdigestive myoelectric complex, were completely abolished postoperatively during ileus, as was the complex itself. Octreotide ameliorated the ileus and restored the interdigestive complexes, but it decreased plasma motilin and did not restore the cyclic increases in motilin found in health, nor did it alter plasma substance P and VIP. In conclusion, octreotide ameliorates postoperative ileus, but it does not do so by increasing plasma motilin or substance P or decreasing plasma VIP.This work was supported by USPHS NIH grants DK18278 and DK07198, a grant from Sandoz Pharmaceuticals, and the Mayo Foundation.An abstract of this work has been published inGastroenterology 103:1382, 1992, and was presented at the biennial meeting of the American Motility Society, September 13–17, 1992, in Lake Tahoe, California.     

肠梗阻导管在结肠癌性肠梗阻治疗中的疗效

目的 探讨肠梗阻导管在急性左半结肠癌性肠梗阻治疗中的临床效果.方法 我科于2007年6月-2007年9月收治2例急性左半结肠癌性肠梗阻病人,急诊肠镜并置入肠梗阻导管,通过肠梗阻导管冲洗管腔.结果 2例病人术后约30 min症状开始减轻,分别于术后17 h、23 h左右症状基本缓解,腹围缩小明显,分别缩小9 cm、12 cm.术后48 h腹部平片较术前明显好转,无并发症发生.术后1周行结肠癌Ⅰ期根治性切除吻合术,手术切口Ⅰ/A级愈合.结论 肠梗阻导管治疗左半结肠癌性肠梗阻操作简单、有效、经济,有临床应用的价值.     

Usefulness of preoperative colonic lavage using transanal ileus tube for obstructing carcinoma of left colon: device to perform one-stage operation safely

Surgical treatments for patients with obstructing carcinoma of the left colon still remain controversial, and many devices to perform a one-stage operation for such cases have been reported. The aim of the current study was to demonstrate the usefulness of preoperative colonic lavage using a transanal ileus tube to perform a one-stage operation for patients with obstructing carcinoma of the left colon. Five patients with intestinal obstruction due to advanced carcinoma of the left colon were investigated. An ileus tube was transanally inserted and placed in the colon proximal to the tumor under the guidance of a colonoscope and guidewire. Preoperative colonic lavage was done with oral administration of an irrigating solution over several days. By using a transanal ileus tube, preoperative colonic lavage can be done, which enables us to safely perform a one-stage operation for patients with obstructing carcinoma of the left colon with no increase in complications or anastomotic leakage.     

Postoperative ileus

Postoperative ileus follows any operation. Although worsened if the peritoneum is entered, the length and duration of surgery does not influence the severity of postoperative ileus. Inhibitory alpha 2-adrenergic reflexes with peptidergic afferents contribute to postoperative ileus. Clinically, treatment of ileus centers around symptomatic relief with nasogastric suction. Trials of adrenergic blockade combined with cholinergic stimulation have met with limited success. Prokinetic drugs have not been proved effective in the treatment of this disorder. Two types of ileus exist: postoperative and paralytic. Postoperative ileus resolves spontaneously after two to three days, and probably reflects inhibition of colonic motility. Paralytic ileus is more severe, last more than three days, and seems to represent inhibition of small bowel activity. No discrete structural changes cause postoperative ileus and the role of peptidergic neuronal systems of the enteric nervous system has not been elucidated. Possible central or humoral mechanisms have not been studied extensively. The possible direct inhibition of enteric or spinal nerves by anesthetic agents not cleared from these tissues remains to be studied. Also in need of study is the potential alteration of neurotransmitter receptor activity within the enteric nervous plexus after manipulation of the bowel.     

Mechanical ileus caused by a tablet of tralgit SR 100 stuck in a stenotic rectum affected by carcinoma: case report and literature survey

A patient with an advanced carcinoma in the recto-sigmoideum was taken for urgent operation because of abdominal pain, significant distension of colon, clinical symptoms and radiological proofs of ileus. The cause of the complete obstruction of the proximal rectum which was significantly narrowed by a tumour was one tablet of Tralgit SR 100, which had been administered to the patient for 4 weeks after osteosynthesis of the right femur neck following fracture. According to the radiologist between 45 and 50 tablets of the medicament had been found in the digestive tract. The mechanical ileus was solved by operation according to Hartmann. This case has two aspects: 1) surgical--mechanical ileus resulting from a rare set of circumstances, and 2) pharmacological and metabolic--disorder of medicament absorption in the digestive tract. The cause of maldigestion (disorder of absorption) of the Tralgit tablets is further investigated.