Enteroenterale Invagination des Dünndarms beim Erwachsenen

Zusammenfassung Es wird über eine 43jährige Patientin berichtet, die mehrere Wochen lang über inkonstant auftretende, krampfartige Mittelbauchschmerzen klagte. Die Diagnose einer ileoilealen Invagination konnte bei der Patientin erst beim dritten stationären Aufenthalt gestellt werden. Folgende Fehldiagnosen waren während des 4wöchigen Verlaufs bei der Patientin gestellt worden: Nierenbeckenentzundung, acute Appendizitis, chronische Appendizitis und zuletzt psychosomatische Bauchschmerzen. Die Patientin wurde zunächst antibiotisch, zuletzt mit Psychopharmaka medikamentös behandelt. Schließlich wurde die Diagnose einer Invagination des Dünndarms mittels Sonographie vermutet und in der konventionellen fortlaufenden Magen-Darm-Passage röntgenologisch gesichert. Bei der Patientin wurde daraufhin eine Dünndarmsegmentresektion durchgeführt. Die enteroenterale Invagination ist im Erwachsenenalter ein sehr seltenes Ereignis, bei der meistens eine Ursache (oft Tumore) als Auslöser der Invagination ermittelt werden kann. Durch Peristaltik und Ingesta wird der nach aboral bewegte Tumor zum Motor der Invagination. Prädilektionsorte sind die Übergänge eines beweglichen zu einem retroperitoneal fixierten Darmabschnitts (z. B. Ileozökalregion). Die Sonographie des Abdomens ist die Methode der ersten Wahl bei der Diagnose einer enteroenteralen Invagination. Beim Erwachsenen ist die operative Beseitigung der Invagination und deren Ursache (meist Tumore) angezeigt.

---

Entero-enteric invagination of the small intestine in adultsA rare cause of abdominal distress

The present paper reports on a 43-year-old female patient who complained over a number of weeks of paroxysms of crampy pain in the mesogastrium. The diagnosis of ileoileal invagination was only made after she had been admitted to hospital for the third time. The following false diagnoses had been made during the 4-week course of the condition: pyelonephritis, acute appendicitis, chronic appendicitis and, most recently psychosomatic abdominal distress. The patient was initially treated with antibiotics and finally with psychotropic drugs. Eventually ultrasound suggested the diagnosis of invagination of the small intestine, which was then verified by conventional barium follow-through radiography. The patient subsequently underwent resection of a segment of the small intestine. Entero-enteric invagination is a very rare event in adults, in which a single (often malignant) cause is identified as triggering the invagination. Peristalsis and ingested food push the tumor distad, thus acting as a motor for invagination. The preferred localizations are the junctions between freely moving segments to retroperitoneally fixed segments (e.g., ileocecal region). Ultrasound of the abdomen is the examination of choice for diagnosis of enteroenteric invagination. Surgical resection of the invagination and its cause (generally tumors) is indicated in adults.

     

Surgery for Syringomyelia: An Analysis Based on 163 Surgical Cases

Summary ? Object. The authors analyzed the cases of 163 patients with syringomyelia to assess the appropriate surgical procedure. Methods. Depending on the aetiological factors and treatment considerations the series was classified into three groups. Group I were cases where there was no definite demonstrable aetiological factor; Group II cases had basilar invagination and/or Chiari malformation; and Group III consisted of cases where the syrinx was secondary to an obvious aetiology, such as a mass lesion either in the posterior cranial fossa or in the spine or a severe kyphotic spinal deformity. Post-traumatic syringomyelia and syrinx in association with spina bifida were not studied. Conclusions. We concluded that for Group I cases syringosubarachnoid shunting is the ideal form of treatment. In Group II cases foramen magnum bony decompression is satisfactory and physiological. Good results were obtained even in cases where either a foramen magnum decompression alone or in combination with a syringo-subarachnoid shunt was done. Only syringosubarachnoid shunt (without a foramen magnum decompression) in Group II cases was found to produce poor outcome. Group III cases should be treated for the primary aetiological problem. Only syrinx drainage procedure without treatment of aetiology in these cases produced poor results. It was observed that clinical outcome rather than radiological improvement is the reliable indicator of the surgical result.     

Laparoscopic surgery in the management of intussusception in children

Summary

The technique and outcome of minimally invasive laparoscopic treatment of various forms of intussusception in children after ineffective attempts at conservative treatment are described. 118 patients, aged from 1.5 months to 11 years were analysed. The suggested scheme of surgical treatment using a laparoscopic technique was successful in 82 patients (69.5%), and conversion to an open procedure occurred in 36 (30.5%). There was no mortality or intraoperative complications in our series. It is concluded that practically every form of intussusception without bowel necrosis, including the most complex forms, can be radically disinvaginated using modern video-laparoscopic equipment and atraumatic instruments.     

前后路联合治疗颅底凹陷合并小脑扁桃体下疝患者的临床疗效及预后分析

目的分析前后路联合治疗颅底凹陷合并小脑扁桃体下疝（Chiari）畸形患者的临床疗效及预后。方法选取2009年2月~2016年2月诊治的12例颅底凹陷症合并Chiari畸形患者。分析患者术后的临床疗效、影像参数变化及预后。结果所有患者术后随访7 d至20个月，患者的临床症状、体征均有明显的改善；术后的JOA评分（14.14±2.04）分明显高于术前的JOA评分（6.65±1.23）分（P<0.05）；12例患者术后CL值、ML值、WL值、Klaus高度指数、延颈髓角及颅底角参数较术前明显改善（P<0.05）；术后并发症少。结论经前后路联合治疗颅底凹陷合并小脑扁桃体下疝患者的临床效果较好，对脊髓功能改善明显，并发症发生率少，短期预后良好。     

成人单纯Arnold-Chiari畸形颅颈交界区CT参数测量

目的探讨不合并颅底凹陷的单纯Arnold-Chiari畸形(Arnold-Chiari malformation,ACM)颅颈交界区CT参数的变化。方法对40例成人单纯ACM和20例正常成人对照组头颈CT原始数据行正中矢状位重建,研究颅颈交界区CT线性及角度参数的变化。结果单纯ACM患者的斜坡长[(40.66±3.11)mm vs(43.44±3.34)mm,P<0.01]、齿突Chamberlain线间距[(1.23±2.41)mm vs.(1.25±2.29)mm,P<(0.001)]、齿突McRae线间距[(4.04±1.39)mm vs.(4.95±1.29)mm,P(<0.05)]、斜坡椎管角(147.93°±7.84°vs.157.33°±8.51°,P<0.001)、减压枕骨角(139.11°±10.14°vs.144.49°±8.03°,P<0.05)明显小于对照组,而斜坡McRae线角(130.82°±7.85°vs.124.60°±7.35°,P<0.01)、减压枕骨椎管角(127.71°±11.75°vs.118.86°±11.33±,P<0.01)明显大于对照组,差异具有统计学意义。结论成人单纯ACM斜坡长度较正常人明显缩短,枕骨大孔区附近枕骨倾斜角度明显增加。     

The Nature and Management of Complications in Carotid Artery Stenting

Intussusception is rare in adults and it can be a challenge to diagnose on admission. Non-specific and variable signs and symptoms, frequently only occurring episodically, may cause a considerable delay before treatment. However, in 90% a predisposing organic cause can be found in adults.

A case is presented of small bowel intussusception secondary to a lipoma in a 54-year-old man in whom diagnosis was suggested by CT-scan. The patient was treated with a laparoscopic-assisted reduction and extracorporeal partial small bowel resection, followed by a latero-lateral anastomosis.

This case serves as the basis of a review of small bowel intussusception in adults secondary to lipomas. It focuses on the rarity of the disease, but stresses the need for early referral and investigation in middle-aged patients with recurrent abdominal symptoms.     

单纯经后路手术治疗先天性颅底陷入症合并的寰枢椎脱位

目的 探讨单纯经后路手术治疗先天性颅底陷入症合并寰枢椎脱位的效果.方法 2008年4月至2012年2月,对25例先天性颅底陷入症合并寰枢椎脱位患者,采用单纯经后路手术,术中行C2椎弓根和C1侧块或枕骨螺钉内固定及螺钉间撑开技术,对手术效果进行分析总结.结果 所有患者术前术后均未行经口齿状突切除.随访6～40个月,无患者出现症状恶化,22例患者症状有不同程度改善.术后影像学检查显示,所有患者均复位满意,减压充分,24例患者形成良好骨性融合.结论 单纯后路复位及固定结合术中螺钉间撑开技术,可以安全有效地治疗先天性颅底陷入症.     

颅底凹陷合并难复性寰枢椎脱位术后齿状突下移程度对神经功能影响的临床研究

目的分析颅底凹陷合并难复性寰枢椎脱位术后齿状突下移程度与术后神经功能恢复的关系。方法回顾性分析2010—2018年在我院诊断为颅底凹陷合并难复性寰枢椎脱位并行后路减压治疗的患者19例,其中男10例,女9例;平均(41.89±14.27)岁;病程持续(42.61±70.71)个月。10例合并寰枕融合,7例合并Klippel-Feil综合征,4例合并椎动脉发育畸形,无病例合并小脑扁桃体疝及脊髓空洞等。测量术前及末次随访寰齿前间隙(anterior atlantodental interval,AADI)、斜坡齿突角(clivo-axial angle,CXA)及齿状突上移程度(the distance of the tip of odontoid to the McRae line,McRL),采用日本骨科协会评分(Japanese orthopaedic association scores,JOA)评估神经功能。对JOA评分改善率与齿状突下移率(odontoid descent rate,ODR)、寰齿前间隙变化(△AADI)和斜坡齿突角变化(△CXA)进行相关性分析。结果本组患者获得随访时间10~79个月,平均随访时间(20.42±8.24)个月。术前JOA为(11.21±2.62)分,末次随访JOA为(14.53±2.19)分,平均JOA改善率为(58.75±24.43)%。JOA评分改善率与ODR存在相关关系(R=0.88,P<0.05),与△AADI(R=0.07,P=0.77)及△CXA(R=-0.04,P=0.98)无明显相关性。结论难复性寰枢椎脱位合并颅底凹陷的手术疗效与齿状突复位率相关。     

应用C1-2螺钉棒系统行后路复位、固定和融合治疗合并寰-枢椎脱位的颅底凹陷症

目的探讨应用C1-2螺钉棒内固定系统行后路复位、固定和融合治疗寰枢椎脱位的手术疗效。方法 2013年4月至2013年10月,对30例我科收治的合并寰枢椎脱位的颅底凹陷症患者采用寰椎侧块螺钉和枢椎椎弓根峡部螺钉(或下关节突螺钉、颈3椎弓根螺钉)棒内固定系统进行复位、固定并取髂后上嵴松质骨植骨融合。通过术后3D-CT评判复位程度,JOA评分评判临床疗效,并探讨影响手术效果的因素。结果 30例患者中26例达到完全复位,4例为部分复位。其中25例完成了3个月以上随访,CT显示植骨愈合良好,未出现植骨的吸收及内固定的松动。结论 C1-2椎弓根钉棒内固定系统对治疗合并寰枢椎脱位的颅颈交界区畸形可以获得满意的疗效,安全可行。