经鼻型肠梗阻导管在腹部术后早期粘连性肠梗阻胃肠减压治疗中的应用

目的探讨经鼻型肠梗阻导管减压在腹部术后粘连性肠梗阻治疗中的作用。方法将136例腹部术后早期粘连性肠梗阻患者随机分为对照组和观察组各68例。对照组行传统鼻胃管置入胃肠减压治疗,48h后腹痛、腹胀无明显缓解者改行经鼻型肠梗阻导管胃肠减压治疗;观察组采用经鼻型肠梗阻导管行胃肠减压治疗。观察两组成功率及腹围减少量、胃肠减压量、平均住院时间。结果观察组成功率、腹围减少及胃肠减压量均明显高于对照组,P均〈0.05;但平均住院时间长于对照组（P〈0.05）。结论经鼻型肠梗阻导管置入胃肠减压效果确切,优于传统的鼻胃管。     

使用刚性引导技术行支架置入术治疗结直肠癌梗阻的疗效分析

目的探讨使用刚性引导技术行金属支架置入术治疗结直肠癌梗阻的可行性及临床疗效。 方法回顾性分析2014年1月至2018年9月收治的77例结直肠癌梗阻患者的临床资料,记录使用刚性引导技术行金属支架置入术的操作时间、术后24 h脐水平的腹围缩小程度、术后腹胀缓解时间、术后不良反应,分析技术成功率,临床成功率和并发症。 结果77例结直肠癌梗阻的患者共置入金属支架85枚,技术成功率100%,手术时间30~240（中位50）min,其中6例患者置入2枚金属支架,1例患者置入3枚金属支架。患者术前测量脐水平的腹围为（107.8±12.1）cm,术后24 h降至（83.9±8.2）cm,缩小程度为（23.4±11.2）cm,术后中位腹胀缓解时间为1.9 d（1~6 d）。肠梗阻症状完全治愈62例（80.5%）,症状改善9例（11.7%）,症状无改善6例（7.8%）,临床成功率为93.5%。3例（3.9%）患者出现腹痛症状,1例（1.3%）患者出现少量便血,无患者发生支架移位。26例患者于金属支架置入术后5~14 d行外科手术治疗,出现伤口感染1例,无肠漏、肠梗阻并发症;51例姑息性治疗患者支架通畅率1个月时为92.2%,3个月时为84.7%,6个月时为68.4%,12个月时为46.9%。 结论数字减影血管造影技术（DSA）下金属支架置入术是治疗结直肠癌梗阻的一种安全有效的治疗措施,同时采用刚性的引导技术可提高技术成功率。     

超细内镜辅助金属支架置入治疗结直肠癌合并急性肠梗阻的临床研究（含视频）

目的 探讨超细内镜辅助置入肠道金属支架治疗结直肠癌合并急性肠梗阻的临床疗效。方法 对56例结直肠癌合并急性肠梗阻患者行超细内镜辅助下置入国产肠道金属支架治疗，观察治疗效果。结果 56例患者中直肠癌11例，乙状结肠癌18例 ，降结肠癌13例，横结肠癌9例，升结肠和（或）回盲部癌5例。肠道支架成功置入52例（92.9%），支架置入手术时间30~90 min，无穿孔、出血、感染及心肺功能意外等并发症。24~48 h内急性肠梗阻缓解52例，支架置入成功后缓解率100.0%。支架置入失败4例（7.1%），均急诊外科手术造瘘治疗。46例患者支架置入后7~10 d行肠癌根治术，术后无一例并发吻合口瘘，无一例术后30 d死亡，3年生存率为58.7%（27/46）。结论 超细内镜辅助肠道金属支架置入治疗结直肠癌合并急性肠梗阻安全、有效，能够及时缓解或消除患者肠梗阻症状，外科根治术后并发症发生率低。     

内镜下经鼻肠梗阻导管置入在难治性肠梗阻手术治疗中的应用效果观察

目的 观察内镜下经鼻肠梗阻导管置入在难治性肠梗阻手术治疗中的应用效果,及术后胃肠道激素变化。方法难治性肠梗阻患者88例,采用随机数字法分为观察组与对照组,每组44例。对照组术前给予常规鼻胃管置入序贯外科手术治疗,观察组术前给予内镜下经鼻肠梗阻导管置入序贯外科手术治疗。观察两组置管情况,记录腹痛缓解时间、腹胀缓解时间、首次排气时间和首次排便时间,记录术后并发症发生情况;分别于术前及术后24、72 h采用ELISA法检测血清血管活性肽（VIP）和胃动素（MTL）。结果 两组均一次性置管成功,置管过程中患者耐受性较好,无消化道出血及穿孔发生。观察组术后腹痛缓解时间、腹胀缓解时间、首次排气时间、首次排便时间均较对照组缩短（P均<0.05）。两组术后24 h血清VIP水平高于术前,血清MTL水平低于术前（P均<0.05）。两组术后72 h血清VIP水平低于术后24 h,对照组术后72 h血清VIP水平仍高于术前（P均<0.05）;两组术后72 h血清MTL水平高于术后24 h,观察组术后72 h血清MTL水平高于术前（P均<0.05）。观察组术后24、72 h血清VIP水...     

经鼻型肠梗阻导管在肠梗阻治疗中的临床价值

目的观察经鼻型肠梗阻导管治疗肠梗阻的临床疗效。方法 28例不全性肠梗阻患者经常规治疗无效后安置肠梗阻导管,观察肠梗阻缓解的各项临床指标,即腹胀、腹痛、腹围变化、腹部立卧位平片气液平消失的时间和非手术率的变化。结果 28例患者,肠梗阻完全缓解者21例,时间24~240 h,其中外科手术后所致黏连性肠梗阻16例,克罗恩病1例,肠结核1例,粪石性肠梗阻1例,小肠柿石2例。非手术率75.0%。肠梗阻未能缓解转外科行手术治疗7例,包括结肠肿瘤3例,小肠癌1例,小肠内疝1例,肠道淋巴瘤1例,小肠巨大粪石1例。结论经鼻型肠梗阻导管治疗不全性肠梗阻可明显改善患者临床症状,提高非手术率,为外科手术病变部位定位。     

小肠减压管联合结肠金属支架置入治疗恶性结肠梗阻的临床研究

目的 探索小肠减压管联合结肠金属支架置入治疗恶性结肠梗阻的临床价值。方法 回顾性队列研究收集2010年6月至2018年9月在浙江大学医学院附属杭州市第一人民医院消化科因恶性结肠梗阻接受消化内镜治疗的患者，根据治疗方案，分为小肠减压管联合结肠金属支架置入组（联合组）和单纯结肠金属支架置入组（单纯组），比较两组在支架操作成功率、并发症发生率、后续外科手术吻合方式及并发症发生率、住院天数及治疗费用等方面的差异。结果 共纳入83例患者，其中联合组18例，单纯组65例，两组患者一般情况比较差异无统计学意义（P>0.05）。联合组与单纯组支架置入成功率比较差异无统计学意义[100%（18/18）比 98.5%（64/65），?2=0.280，P=0.597），支架置入术后并发症发生率比较差异也无统计学意义[5.6%（1/18）比 21.9%（14/64），?2=2.432，P=0.119）。联合在有8例、单纯组有24例在我院行外科手术治疗，联合组支架置入到外科手术时间（6.75±1.28）d，短于单纯组的（9.58±5.76）d（t=3.649，P=0.000），联合组外科术后感染并发症发生率12.5%（1/8），低于单纯组的54.2%（13/24）（P=0.045）。两组手术吻合方式、住院天数、住院费用比较差异无统计学意义（P>0.05）。结论 内镜下金属支架置入或联合小肠减压管治疗恶性肠梗阻安全有效，且金属支架置入前使用小肠减压管可缩短接受外科手术时间，降低外科手术后感染发生率。     

内镜下肠道支架置入术在治疗结直肠癌并肠梗阻中的应用和价值

目的:评价肠道支架在治疗结直肠癌并急性肠梗阻中的安全性、有效性及临床应用价值.方法:收集南昌大学第一附属医院2010-01/2014-12因结直肠癌性梗阻就诊患者,共263例,在内镜下和/或X射线监测下引导行支架置入治疗,分析放置支架成功率,术后并发症发生率,症状缓解率,手术切除率等指标.结果:258例放置支架成功(98.1%);术后发并穿孔1.1%(3例),出血3.8%(10例)、发热4.6%(12例),其他如支架脱落及移位等3.0%(8例);症状缓解率:腹痛97.3%(256例),腹胀98.1%(258例),肛门排便98.1%(258例);手术切除率:60例为姑息性治疗,198例行于支架置入术后5-13 d后行肠道准备后手术治疗,143例行一期手术切除肿瘤.结论:内镜下肠道支架置入能很好地解除肠梗阻症状,其中急诊内镜下支架置入可作为术前过渡治疗,可以将急诊手术转为择期手术,二期手术转为一期手术,减轻临床医生的手术难度和风险、降低术后等并发症发生率,减轻患者痛苦,提高了患者生存质量,值得大力推广应用.     

大黄芒硝及硫酸镁治疗急性重症胰腺炎合并麻痹性肠梗阻的疗效观察

目的探讨大黄芒硝及硫酸镁治疗急性重症胰腺炎合并麻痹性肠梗阻的临床疗效。方法回顾性分析我院近3年来收治的36例急性重症胰腺炎合并麻痹性肠梗阻患者的临床资料,将患者分为2组,治疗组（20）和对照组（16）,比较2组患者的疗效差异。结果对照组16例患者的腹痛、腹胀缓解时间,肠鸣音恢复时间,首次恢复排便时间,血淀粉酶恢复时间,禁食时间及患者住院时间,均明显长于治疗组,经统计学分析,有显著性差异,P〈0.05。而中转手术发生率和死亡率均较低。结论大黄芒硝及硫酸镁治疗急性重症胰腺炎合并麻痹性肠梗阻的疗效确切,值得临床推广使用。     

内镜下光动力治疗在不可切除肝门部胆管癌梗阻性黄疸治疗中的作用研究

目的　探讨内镜下光动力治疗（photodynamic therapy, PDT）联合胆管支架置入在不可切除肝门部胆管癌梗阻性黄疸中的临床疗效。方法　回顾性分析2020年1月至2023年1月中科大附一院（40例）和铜陵市人民医院（3例）收治的共43例不可切除肝门部胆管癌发生梗阻性黄疸的患者临床资料,支架组（n=23）单纯置入胆管支架,联合组（n=20）行PDT联合胆管支架置入。对比两组患者的胆红素下降程度、支架通畅期、术后卡氏行为评分、并发症发生情况及预后情况。采用Cox回归分析患者生存期的影响因素。结果　支架组和联合组一般资料比较差异无统计学意义（P>0.05）。术后联合组的支架通畅时间为204.53 d（95%CI：143.75~265.32 d）,长于支架组的138.36 d（95%CI：95.38~181.34 d）,差异无统计学意义（P=0.091）。支架组和联合组术后1周中位胆红素下降值分别为30.10 μmol/L和9.40 μmol/L,差异无统计学意义（Z=-0.243,P=0.808）。支架组和联合组术后1个月［（69.09±12.69）分和（73.16±13.36）分,t=-0.999,P=0.324］和3个月卡氏行为评分［（67.14±9.94）分和（70.67±10.33）分,t=-0.935,P=0.358］差异无统计学意义。联合组的总体生存期为267.38 d（95%CI：186.93~347.83 d）,显著长于支架组的140.41 d（95%CI：97.38~183.45 d）（P=0.017）。Cox回归多因素分析显示,PDT联合胆管支架置入（HR=0.457,95%CI：0.212~0.986,P=0.046）是患者生存期的独立保护因素。结论　内镜下PDT联合胆管支架置入可有效缓解不可切除肝门部胆管癌的梗阻性黄疸,改善患者的生活质量,延长患者的生存时间。     

奥曲肽联合复方大承气汤治疗术后早期炎性肠梗阻的疗效观察

[目的]探讨奥曲肽联合复方大承气汤治疗术后早期炎性肠梗阻（EPISBO）的临床效果.[方法]选择我院治疗的135例EPISBO患者随机分为对照组（65例）和观察组（70例）.对照组行常规治疗,观察组在对照组的基础上加用奥曲肽联合复方大承气汤治疗.[结果]观察组总有效率明显高于对照组,差异有统计学意义（P＜0.05）;在排气、腹胀、腹痛缓解及住院时间,观察组与对照组比较差异有统计学意义（P＜0.01）.X线摄片阳性征象消失及肠鸣音恢复活跃时间观察组明显短于对照组（P＜0.01）.[结论]奥曲肽联合复方大承气汤对EPISBO患者具有促进患者胃肠功能恢复及缩短病程的优点.     

Comparison of uncovered stent with covered stent for treatment of malignant colorectal obstruction

BACKGROUND: Insertion of self-expandable metallic stents (SEMS) can provide rapid relief of malignant colorectal obstruction and can be used as a palliative treatment or as a bridge to surgery. A SEMS can be classified as an uncovered or covered stent. Both types of stents have their own merits and demerits. OBJECTIVE: The objectives of this study were to compare success rates, durability, and complication rates of uncovered and covered stent groups of malignant colorectal obstruction. DESIGNS AND SETTING: A nonrandomized prospective, single-center study. METHODS: We studied 80 patients with malignant colorectal obstruction: colon cancer in 70 patients, metastatic lesion of advanced gastric cancer in 8 patients, and cervix cancer in 2 patients. Insertion of uncovered stents was attempted in 39 patients (before surgery in 20, palliative in 19), and covered stents were used in 41 (before surgery in 23, palliative in 18). INTERVENTION: The stent was inserted into the obstructive sites for preoperative or palliative purposes by using the through-the-scope method. After stent insertion, the patients had regular follow-ups, either as clinical checkups or telephone interviews. MAIN OUTCOME MEASUREMENT: Insertion success rate, durability, and complication rate according to stent type. RESULTS: Technical and clinical success rates of uncovered and covered stents were not different (100%; 95.1%, P > .05, 100%; 97.4%, P > .05). The early stent migration rate was not different in both groups. The late stent migration was more common in the covered stent group than the uncovered stent group (0% vs 40%, respectively, P = .005). Loss of stent function during the long-term follow-up period was more frequent in the covered stent group than in the uncovered stent group (18.8% vs 60%, respectively, P = .018). LIMITATION: This was a small-sized, nonrandomized, prospective, single-center study. Confirmation of large-scale, multicenter, randomized, prospective outcome is required. CONCLUSIONS: Insertion of either an uncovered or covered stent is similarly an effective treatment modality of malignant colorectal obstruction for preoperative purposes. However, there are no advantages of covered stents over uncovered stents during the follow-up period in the palliative purpose.     

记忆合金支架在胃出口和十二指肠恶性梗阻中的应用

目的：探讨胃出口、十二指肠恶性梗阻时镍钛记忆合金支架置入的操作技术及其临床疗效：方法：16例中胃窦癌2例，胃窦癌术后复发伴吻合口狭窄2例，贲门癌术后复发伴幽门梗阻4例，结肠癌晚期伴胆管、十二指肠恶性梗阻1例，胰头癌浸润十二指肠3例，十二指肠癌4例。所有患者均在X线监视下行气囊扩张后进行支架置入。结果：支架一次置入成功15例，成功率93．8％。其中有2例为双支架置入(同时置胆总管支架)。支架置入后1周，患者腹胀消失率为11／15(73．3％)，呕吐消失率为13／15(86．7％)。未发生与操作相关的近期并发症。结论：采用镍钛记忆合金支架治疗胃出口、十二指肠恶性狭窄，能明显改善患者生存质量，是一种安全有效的治疗方法。     

A temporary self-expanding metallic stent for malignant colorectal obstruction

AIM:To investigate the clinical safety and efficacy of a temporary self-expanding metallic stent(SEMS) for malignant colorectal obstruction.METHODS:From September 2007 to June 2012,33 patients with malignant colorectal obstruction were treated with a temporary SEMS.The stent had a tubular configuration with a retrieval lasso attached inside the proximal end of the stent to facilitate its removal.The SEMS was removed one week after placement.Clinical examination,abdominal X-ray and a contrast study were prospectively performed and both initial and follow-up data before and at 1 d,1 wk,and 1 mo,3 mo,6 mo and 12 mo after stent placement were obtained.Data collected on the technical and clinical success of the procedures,complications,need for reinsertion and survival were analyzed.RESULTS:Stent placement and removal were technically successful in all patients with no procedurerelated complications.Post-procedural complications included stent migration(n = 2) and anal pain(n = 2).Clinical success was achieved in 31(93.9%) of 33 patients with resolution of bowel obstruction within 3 d of stent removal.Eleven of the 33 patients died 73.81 ± 23.66 d(range 42-121 d) after removal of the stent without colonic re-obstruction.Clinical success was achieved in another 8 patients without symptoms of obstruction during the follow-up period.Reinsertion of the stent was performed in the remaining 12 patients with re-obstruction after 84.33 ± 51.80 d of follow-up.The mean and median periods of relief of obstructive symptoms were 97.25 ± 9.56 d and 105 ± 17.43 d,respectively,using Kaplan-Meier analysis.CONCLUSION:Temporary SEMS is a safe and effective approach in patients with malignant colorectal obstruction due to low complication rates and good medium-term outcomes.     

Sodium hyaluronate-based bioresorbable membrane (Seprafilm) reduced early postoperative intestinal obstruction after lower abdominal surgery for colorectal cancer: the preliminary report

Purposes

This study is a prospective randomized clinical trial to evaluate the clinical safety and the effect of a sodium hyaluronate-based bioresorbable membrane (Seprafilm®; Genzyme, Cambridge, MA, USA) for reducing adhesive intestinal obstruction after colorectal cancer surgery.

Materials and methods

Between November 2002 and December 2003, 504 patients underwent radical resection for sigmoid or rectal cancer. Among these patients, 427 patients were enrolled in this study. The patients were randomized into the Seprafilm® group (N?=?185) and the control group (N?=?242). All the patients in the Seprafilm® group received one sheet of Seprafilm® over the pelvic inlet where the peritoneum was denuded due to pelvic dissection. Intestinal obstruction was defined when there were symptoms of nausea, vomiting, and abdominal distension combined with an obstructive bowel pattern on the radiologic evaluation.

Results

The median follow-up period was 25.0 months. There were no significant differences between the Seprafilm® and the control groups for the clinicopathologic parameters. There were no differences in the incidence of complications between the two groups; however, the incidence of early postoperative intestinal obstruction was significantly less in the Seprafilm® group than in the control group (2.7% vs 7.0%, respectively, p?=?0.045). Five patients in the Seprafilm® group experienced postoperative intestinal obstruction (2.7%) compared with 11 patients in the control group (4.6%) during the follow-up period; however, there was no statistical difference.

Conclusions

Seprafilm® appears to be effective in preventing early postoperative intestinal obstruction and there was a trend for reduced intestinal obstruction after lower abdominal surgery for colorectal cancer.     

腹腔镜下"无管化"结直肠手术的临床研究

目的通过改善围手术期处理实现腹腔镜下结直肠手术"无管化";将腹腔镜下"无管化"结直肠手术与传统术后留置鼻胃管、腹腔引流管和导尿管腹腔镜下的结直肠手术在术后恢复和并发症方面进行对照研究,进一步论证腹腔镜下"无管化"结直肠手术的可行性和安全性。 方法将49例结、直肠恶性肿瘤患者随机分为常规留置"三管"手术组（对照组）（23例）、"无管化"手术组（TF组）（26例）。比较患者基线特征指标、术后恢复指标、生活质量量表（QoR-40）评估、术后安全性指标。 结果"无管化"手术组有3人术后发生尿潴留;"无管化"手术组与对照组相比,其术后阿片类镇痛药物的使用天数（Z=5.241,P<0.001）和住院天数明显缩短（t=3.21,P=0.002）,差异均有统计学意义。两组患者在吻合口漏、肠梗阻、切口感染、肺部感染、心力衰竭、深静脉血栓和心脑血管意外等并发症的发生率方面差异无明显统计学意义（均P>0.05）。"无管化"手术组术后48 h QoR-40总分明显高于对照组（Z=5.774,P<0.01）;其中"无管化"手术组在身体舒适度、自理能力和疼痛方面的评分明显优于对照组（P<0.01）。 结论在结直肠手术后常规留置鼻胃管、导尿管和腹腔引流管并不能使患者获益;而"无管化"结直肠手术通过减少患者术后不适,明显改善患者术后恢复质量,且不增加术后短期并发症的发生;是一种安全、可行的治疗措施。     

Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents

Malignant gastroduodenal obstruction can occur in up to 20% of patients with primary pancreatic, gastric or duodenal carcinomas. Presenting symptoms include nausea, vomiting, abdominal distention, pain and decreased oral intake which can lead to dehydration, malnutrition, and poor quality of life. Endoscopic stent placement has become the primary therapeutic modality because it is safe, minimally invasive, and a cost-effective option for palliation. Stents can be successfully deployed in the majority of patients. Stent placement appears to lead to a shorter time to symptomatic improvement, shorter time to resumption of an oral diet, and shorter hospital stays as compared with surgical options. Recurrence of the obstructive symptoms resulting from stent occlusion, due to tumor ingrowth or overgrowth, can be successfully treated with repeat endoscopic stent placement in the majority of the cases. Both endoscopic stenting and surgical bypass are considered palliative treatments and, to date, no improvement in survival with either modality has been demonstrated. A tailored therapeutic approach, taking into consideration patient preferences and involving a multidisciplinary team including the therapeutic endoscopist, surgeon, medical oncologist, radiation therapist, and interventional radiologist, should be considered in all cases.     

金属支架治疗肠道恶性梗阻的临床研究

目的探讨金属自膨式支架治疗肠道恶性梗阻的临床疗效及意义。方法对1999年至今我院消化科门诊和住院的31例肠道恶性梗阻患者进行金属自膨式支架置入术。结果31例均放置成功，患者恶心、呕吐、排便困难等梗阻症状得到缓解，生活质量得到提高。结论金属自膨式支架无论是在肠道恶性梗阻无法手术、手术后复发还是在肿瘤切除术后吻合口狭窄等情况下，均可解决梗阻，达到提高患者生存质量的目的。     

内镜下大肠支架置入术在老年结直肠癌并急性肠梗阻患者中的应用

目的 探讨内镜下大肠支架置入在老年人结直肠癌并急性肠梗阻的临床应用价值.方法 65岁以上结直肠癌并急性肠梗阻患者82例,分为大肠支架组41例,行Niti-S肠道支架置入;以及急诊手术组41例,根据术中探查结果分别行肿瘤切除及结肠造瘘.比较两组的平均住院日,平均住院费用,中位生存时间,1年生存率,围手术期病死率,手术并发症等情况.结果 大肠支架组平均住院日(17.9±6.7)d,平均住院费用40 047元,中位生存时间(9.4±4.4)个月,1年生存率43.9%.急诊手术组平均住院日(24.4±4.6)d,平均住院费用61 867元,中位生存时间(8.8±4.8)个月,1年生存率36.6%.结论 大肠内支架对于结直肠癌合并肠梗阻的老年患者是一种安全、经济、有效的治疗方式.

Abstract：

Objective To evaluate the clinica1 value of endoscopic placement of colorectal metal stents for malignant colonic obstruction in aged patients. Methods The 82 cases who were older than 65 years with malignant colonic obstruction were randomly divided into colorectal metal stenting group who were treated with endoscopic Niti-S colorectal metal stenting and emergency surgery group who were treated with tumor resection or colostomy. The average length of stay, average hospitalization charge, median survival time, one-year survival rate, perioperative mortality, and the complications such as anastomotic leakage, incision infection were analyzed. Results In colorectal metal stenting group, in 39 of 41 patients, metal stents were successfully inserted, without complications of hemorrhage, perforation and so on. And the symptoms of obstruction were effectively relieved within 2 days. The 17 cases underwent subsequent elective radical resection of colorectal carcinoma after 1 week, without complications of anastomotic leakage. The 22 cases were treated with colorectal metal stenting for palliative treatment. There were 4 cases of stent migration and 5 cases of stent obstruction again. The average length of inhospital stay was (17.9±6.7) days, the average hospitalization charge was 40 047 yuan, the median survival time was (9.4±4.4) months, and one-year survival rate was 43.9%. In emergency surgery group, 13 cases underwent tumor resection and 28 cases received colostomy. The 14 cases presented with multiple organ dysfunction, 8 cases died preoperatively, 4 cases presented with anastigmatic leakage. The average length of stay was (24.4±4.6) day, the average hospitalization charge was 61 867 yuan, the median survival time was (8.8±4.8) months, and one-year survival rate was 36.6%. Conclusions Endoscopic colorectal metal stenting is a safe, economic and effective treatment for malignant colonic obstruction in aged patients, especially reduces the risk of surgical complications, improves the aged patient's quality of life.