小肠减压管联合泛影葡胺在术后早期炎性肠梗阻治疗中的作用

目的评价经鼻置入小肠减压管行小肠减压、并注入泛影葡胺行小肠造影在术后早期炎性肠梗阻治疗中的作用。方法首都医科大学附属北京同仁医院普通外科于2011年4月至2012年7月间有12例腹部手术患者术后早期出现炎性肠梗阻，经鼻胃管减压等常规保守治疗2周后，肠梗阻症状改善不明显，遂经鼻置人小肠减压管行小肠减压，同时经减压管注入泛影葡胺行小肠造影，了解小肠蠕动情况及肠道梗阻情况，并利用泛影葡胺促进肠蠕动的治疗作用，观察其治疗效果。结果在置入小肠减压管后，12例患者腹胀症状均有所缓解，其中11例在置入小肠减压管后3周内腹部坚韧感消失，恢复正常排气并逐渐开始经口进食；1例患者在50d后仍未排气，再次行手术治疗，术后3d患者恢复自主排气。随访6个月，全组患者无一例复发肠梗阻。结论对于症状较重、病程较长并经常规处理无效的术后早期炎性肠梗阻患者，应用小肠减压管行小肠减压并注入泛影葡胺行小肠造影的方法安全有效，能够避免二次手术。

Role of the small intestinal decompression tube and Gastrografin in the treatment of early postoperative inflammatory small bowel obstruction

Objective To evaluate the role of the small intestinal decompression tube （SIDT） and Gastrografin in the treatment of early postoperative inflammatory small bowel obstruction （EPISBO）. Methods Twelve patients presented EPISBO after abdominal surgery in our department from April 2011 to July 2012. Initially, nasogastrie tube decompression and other conventional conservative treatment were administrated. After 14 days, obstruction symptom improvement was not obvious, then the SIDT was used. At the same time, Gastrografin was injected into the small bowel through the SIDT in order to demonstrate the site of obstruction of small bowel and its efficacy. Results In 11 patients after this management, obstruction symptoms disappeared, bowel function recovered within 3 weeks, and oral feeding occurred gradually. Another patient did not pass flatus after 4 weeks and was reoperated. After postoperative follow-up of 6 months, no case relapsed with intestinal obstruction. Conclusion For severe and long course of early postoperative inflammatory intestinal obstruction, intestinal decompression tube plus Gastrografin is safe and effective, and can avoid unnecessary reoperation.