直肠癌Miles术后并发内疝性肠梗阻的防治(附5例报告)

目的:探讨直肠癌Miles术后内疝性肠梗阻的原因、预防和诊治.方法:对1998年1月至2006年10月间收治的直肠癌Miles术后并发内疝性肠梗阻5例进行回顾性分析.结果:Miles术后并发内疝性肠梗阻的发生率为6%(5/82),表现术后不同程度的腹胀,阵发性腹痛,呕吐,胃管引流液每天超过500 mL者,结肠造瘘口无排气排便;腹部轻压痛,肠鸣音活跃或亢进.腹部立、卧位X线片检查,均发现肠腔扩张、多个液平或孤立性肠袢扩张.5例均行剖腹探查而证实,疝内容物为回肠,其中行单纯粘连松解复位2例,部分回肠切除、端端吻合术3例.再次手术后均痊愈出院.结论:Miles术后内疝性肠梗阻常缺乏典型的临床表现,早期诊断和及时剖腹探查是处理的关键,其重点在于预防.     

腹腔镜下膀胱根治性切除及尿流改道术后肠梗阻原因分析(附116例报道)

目的:探讨腹腔镜下膀胱根治性切除及尿流改道术后发生肠梗阻的相关危险因素。方法:回顾分析我院2012年1月~2016年7月期间行腹腔镜下膀胱根治性切除+尿流改道术116例患者的临床特征与术后肠梗阻之间的相关性。结果:14例(12.1%)患者术后发生肠梗阻,与无肠梗阻患者比较,肠梗阻患者年龄较大(均值73.07岁vs.67.68岁,P=0.045),体重指数(BMI)偏大(均值24.95kg/m~2 vs.23.68kg/m~2,P=0.006),有腹部手术史患者肠梗阻发生率更高[50%(7/14)vs.19.6%(20/102),P=0.029];术后肠梗阻与性别、术前血红蛋白及血肌酐、手术时间、术中失血量、淋巴结清扫、尿流改道方式、术后白蛋白、血电解质、肿瘤病理分期等因素均无相关性;多因素回归分析显示年龄(OR=0.900,95%CI 0.828~0.978,P=0.013)、BMI(OR=0.441,95%CI0.271~0.717,P=0.001)、腹部手术史(OR=10.206,95%CI 2.320~44.905,P=0.002)与术后肠梗阻的发生具有相关性。结论:腹腔镜下膀胱根治性切除及尿流改道术后肠梗阻的发生与年龄、BMI、腹部手术史显著相关,高龄和肥胖患者术后发生肠梗阻的危险性增加,且有腹部手术史者肠梗阻发生率更高。     

结直肠癌术后早期炎性肠梗阻的相关危险因素

目的:探讨结直肠癌术后早期炎性肠梗阻的发生及预防策略.方法:回顾性分析120例结直肠癌术后早期炎性肠梗阻患者的临床资料,对其发生的相关危险素进行单素及多素分析.结果:早期炎性肠梗阻与年龄(P=0.023)、手术方式(P=0.008)、腹部手术史(P=0.002)、肠道准备情况(P<0.001)、术中防粘连剂使用(P=0.006)、手术时间(P=0.042)有关;开腹手术(P=0.024)、有腹部手术史(P=0.034)及术前未行肠道准备(P=0.006)是结直肠癌术后早期炎性肠梗阻发生的独立危险素.结论:开腹手术、有腹部手术史及术前未行肠道准备是结直肠癌术后早期炎性肠梗阻发病的独立危险素.     

急性化脓性阑尾炎术后早期炎性肠梗阻1例

术后早期炎性肠梗阻是术后早期肠梗阻的一种特殊类型,大多数患者于术后1～2周内发病,由于腹腔内炎症及腹部手术创伤等原因引起肠壁水肿和渗出、肠麻痹、肠蠕动减弱,从而出现肠梗阻,机械性和动力性梗阻因素均存在,临床上正确区分炎性肠梗阻与粘连性肠梗阻是比较棘手的问题,现实中两者常常并存,笔者对1例阑尾炎术后并发早期炎性肠梗阻患者的资料进行总结,报道如下。     

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1　术后早期炎性肠梗阻的定义腹部手术后并发的肠梗阻有多种类型 ,并且术后不同时期所发生的肠梗阻原因也不相同。术后早期炎性肠梗阻(ｅａｒｌｙｐｏｓｔｏｐｅｒａｔｉｖｅｉｎｆｌａｍｍａｔｏｒｙｉｌｅｕｓ ,ＥＰＩＩ)发生在腹部手术后早期 ,系指由于腹部手术创伤或腹腔内炎症等原因导致肠壁水肿和渗出 ,形成的一种机械性与动力性同时存在的粘连性肠梗阻 ,腹部手术创伤指广泛分离肠管粘连、长时间的肠管暴露以及其它由于手术操作所造成的肠管损伤。腹腔内炎症指无菌性炎症 ,如腹腔内积血、积液或其它能够导致腹腔内无菌性炎症物质的残…     

腹部手术后早期肠梗阻54例分析

目的探讨腹部手术后早期肠梗阻的临床特点,以及治疗方法和预防措施。方法回顾性分析54例腹部手术后早期肠梗阻的临床资料。结果经胃肠减压、抗感染、营养支持及激素等综合治疗后54例均治愈,平均治愈时间为12.5d。54例均获得随访,随访时间为1～4周,未见没有复发病例。结论术后早期肠梗阻多发生在术后2周内,临床上有典型的肠梗阻症状和体征,多为小肠炎性水肿粘连所致,非手术治疗效果好。     

复方大承气汤治疗术后粘连性肠梗阻68例

术后粘连性肠梗阻是妇科腹部手术后常见并发症之一,一般发生在术后1～3周内.我院2001-2004年行妇科腹部手术628例,术后发生粘连性肠梗阻68例,发生率10.8%,采用中西医结合治疗,取得满意疗效,报告如下.     

术后早期炎性肠梗阻的诊断与治疗

一、术后早期炎性肠梗阻的定义术后早期炎性肠梗阻(early postoperative in-flammatory ileus,EPII)是腹部大手术后的常见并发症。这类肠梗阻有其特殊性,其临床特点与术后早期的肠麻痹、内疝、扭转、吻合口狭窄、肠粘连等机械性因素所致的肠梗阻不尽相同,处理方法有别。EPII发生在腹部手术后早期(2周左右),是指由于腹部手术创伤或腹腔内炎症等原因而导致肠壁水肿和渗出所形成的一种机械性与动力性同时存在的粘连性肠梗阻。EPII常发生在由于手术操作范围广,手术时间长、出血多,手术污染严重的病人,由于创伤重或已有炎症、腹腔渗出液较多…     

柴汤保留灌肠治疗炎性肠梗阻的疗效观察

炎性肠梗阻这一概念是由南京军区南京总医院黎介寿院士提出,指发生在术后1～2周内,是由腹部手术创伤或腹腔内炎症等导致肠壁渗出和水肿,形成的一种机械性和动力性同时存在的肠梗阻,以粘连性肠梗阻多见,约占术后肠梗阻的80%～90%[1]。在临床实践中,非手术治疗逐渐成为本病的首选治疗方法,尤其是中西医结     

下肢屈曲活动和腹部按摩促进胃肠蠕动的临床观察

选择 132例粘连性肠梗阻再手术病人 ,随机分为观察组 (除常规护理外 ,采用下肢主动或被动屈曲活动和腹部按摩 )和对照组 (采用常规护理方式 )。观察两组病人术后肠鸣音恢复时间、肛门排气时间和炎性肠梗阻的发生率。结果表明 :观察组病人术后肠鸣音恢复时间和肛门排气时间较对照组明显提前 (P<0 .0 1) ;炎性肠梗阻的发生率明显降低 (P<0 .0 5 )。提示 :下肢屈曲活动和腹部按摩可阻止肠间袢的粘连 ,促进胃肠蠕动 ,减少粘连性肠梗阻的发生 ,从而提高护理服务质量。     

腹腔内恶性肿瘤术后肠梗阻的治疗

目的:研究腹腔内恶性肿瘤术后肠梗阻的最佳治疗方法。方法:对我院自1994年8月～2002年7月八年间共收治的63例腹腔内恶性肿瘤术后肠梗阻进行回顾性研究。将63例患者依据梗阻原因的不同分为三组:原因暂时不明组、肠粘连组及肿瘤广泛转移组,对三组的治疗结果进行统计学分析。结果:肠梗阻原因暂时不明组17例,占总病例的27％,经保守治疗后,15例治愈,2例死亡。粘连性肠梗阻19例(30.2％),经剖腹手术13例,1例死亡,3例出现各种不同并发症;经腹腔镜手术6例。6例完全治愈,无1例并发症发生。肿瘤广泛转移致肠梗阻组27例,单纯化疗5例,治愈3例,死亡2例;剖腹手术或加化疗14例,2例死亡,4例发生各种不同并发症,治愈12例;经腹腔镜手术或加化疗8例,完全治愈,其中1例发生肺炎。在明确梗阻原因病例中,粘连性肠梗阻占41.3％,肿瘤广泛转移致肠梗阻占58.7％。腹腔镜手术或加化疗患者的并发症与剖腹手术或加化疗相比,降低有显著性差异,P<0.05。结论:腹腔内恶性肿瘤术后肠梗阻的最佳治疗方法应在保守治疗同时,明确病因,针对不同病因予以腹腔镜手术或加以化疗。     

The meaning of ileus. Its changing definition over three millennia

Ileus comes from the Greek word for twisted. The early classical literature suggests that this term was used for what we now call sigmoid volvulus. The Romans translated this word as volvulus. During later classical times, investigators used ileus and volvulus in describing conditions other than sigmoid volvulus. Roman investigators used ileus to describe midgut volvulus, intussusception, and incarcerated hernias because the symptoms of these conditions were similar. During the Renaissance, ileus, volvulus, and intussusception were synonymous and were closely linked to the volgar terms iliac passion and Miserere Mei. The sine qua non of ileus was the clinical triad of abdominal pain, obstipation, and fecal vomiting. Autopsies in the 16th, 17th, and 18th centuries exposed the various causes of these symptoms. Ileus became the clinical diagnosis whereas such terms as intussusception were used to describe autopsy findings. Physicians classified diseases by symptoms not by cause. During the 19th century, emphasis switched to the pathologic basis of disease. The classification of intestinal obstruction became one of cause. Ileus was abandoned because its classical definition did not encompass all forms of intestinal obstruction. In the last 50 years, ileus has been relegated to mean nonmechanical obstruction that does not initially require operative treatment. Thus, ileus which was the twisted intestine of Ascelpiades, the Miserere Mei of Paré and the iliac passion of Barrough, has come in the 20th century to mean nonmechanical intestinal obstruction.     

脾曲远端结直肠癌合并肠梗阻经肛肠梗阻导管置入治疗47例分析

目的探讨经肛肠梗阻导管置入治疗脾曲远端结直肠癌合并肠梗阻的可行性,同时评价其安全性。方法回顾性分析2009年7月至2013年6月收治的脾曲远端结直肠癌合并肠梗阻患者93例,其中传统手术治疗组46例,肛肠梗阻导管置入组47例,采用统计学软件SPSS 16.0对记录的临床数据进行分析,计量资料采用t检验,用(x珋±s)表示;计数资料采用χ2检验,P0.05表示差异具有统计学意义。结果肛肠梗阻导管置入组患者的腹围周长、腹内压、梗阻近端肠管的最大横径明显减小,胃管、导管引流量明显减少,与置管前比较差异显著,均具有统计学意义(P均0.05);肛肠梗阻导管置入组腹部症状的缓解率达到93.62%且明显高于传统手术治疗组(10.87%);肛肠梗阻导管置入组并发症发生率、总住院时间、总住院费用也明显低于传统手术治疗组(P均0.05)。结论经肛肠梗阻导管置入治疗脾曲远端结直肠癌合并肠梗阻,取得十分显著的临床疗效,提高患者的存活率和康复率,安全有效,应在临床上大力推广使用。     

Intestinal gallstone obstruction

Three cases of intestinal obstruction due to obturation with gallstones are presented. These patients made 1,3% of all patients operated for acute intestinal obstruction and 0,2% of all patients operated for cholelithiasis. This variant of intestinal obstruction is rare disease and is not characterized with a typical picture and specific symptoms. Analysis of complaints, anamnesis, additional methods of abdominal examination help to suspect biliary ileus. In emergency cases scope of surgery must be minimal and directed to adequate elimination of intestinal obstruction. Indications for simultaneous disjunction of biliodigestive fistula depend on many factors which must be regarded individually for each patient.     

经肛肠梗阻导管在急性结直肠癌性梗阻治疗中的应用研究

目的初步评价经肛型肠梗阻减压导管在急性结直肠癌性梗阻治疗中的应用价值。方法 19例急性完全性机械性结直肠癌性梗阻患者在结肠镜和X线辅助下,行经肛肠梗阻导管置入术,冲洗引流7～10 d后行一期根治手术。结果 19例患者置管减压引流全部成功。全部病例腹痛缓解,腹胀、呕吐症状消失;置管后第3 d,腹围由（89.8±2.7）cm减小到（73.1±5.1）cm,腹腔内压力由（24.0±3.7）cmH2O减至（11.6±2.2）cmH2O;胃管引流量从（750.0±110.3）ml下降至（10.5±8.7）ml;减压导管引流量从（1 634.7±114.2）ml下降至（8.4±1.7）ml;梗阻近端肠管最大横径从（5.6±1.1）cm缩小至（1.7±0.4）cm（P=0.001或P〈0.01）。所有病例均接受一期手术治疗,无吻合口漏、感染等并发症发生。结论经肛肠梗阻减压导管在治疗急性结直肠癌性梗阻中,具有有效、安全、经济、创伤小的特征,值得推广。     

Gallstone ileus as a complication of acute cholecystitis. Laparoscopic diagnosis and treatment

Gallstone ileus accounts for 1-4% of all cases of intestinal obstruction, with its incidence rising with age of patients. There is often a long delay between onset of symptoms (usually abdominal pain, vomiting, and bowel distension) and proper treatment, with a simple enterolithotomy as the one of choice. We report a case of an atypical gallstone ileus presented as a complication of acute cholecystitis, treated with a laparoscopic guided enterolithotomy. A 67-year-old woman on the 5th p.o. day after a laparoscopic procedure for an empyematous cholecystitis (no sign of fistula or duodenal perforation and a "negative" intraoperative cholangiography) presented continuous vomiting as the only symptoms of a subileus (radiographic diagnostic images negative for intestinal obstruction or intraluminal gallstone or duodenal fistula). A laparoscopic diagnostic approach revealed a gallstone in the distal jejunum. Through a 5 cm midline incision the intestine, including the gallstone, was brought out extracorporally and the stone was removed by a simple enterolithotomy. The postoperative course was uneventful and the patient had no complaint at a 1-year follow-up. We consider the laparoscopic approach, in patients with "abdominal emergencies," feasible and safe in experienced hands. It provides diagnostic accuracy as well as therapeutic capabilities, as in the case of gallstone ileus we have reported.     

Gallstone ileus of the sigmoid colon: a rare complication of cholelithiasis

The authors report a case of gallstone ileus of the sigmoid colon in an 80-year-old woman admitted to the hospital with symptoms and signs of large bowel obstruction and asymptomatic cholelithiasis. Radiological investigation (abdominal X-ray and CT scan) showed a large gallstone impacted in the sigmoid colon. At first, the patient was managed conservatively, but the recurrence of the intestinal obstruction required open cholecystectomy, suturing of the colonic fistula and sigmoidectomy.     

生长抑素联合肠梗阻导管治疗粘连性肠梗阻

目的 探讨生长抑素联合肠梗阻导管在粘连性肠梗阻非手术治疗中的应用价值.方法 将91例粘连性肠梗阻患者按入院顺序随机分为A组(生长抑素+肠梗阻导管组),B组(生长抑素+鼻胃管减压组),C组(肠梗阻导管组)和D组(鼻胃管组).常规治疗包括禁食、纠正水电解质和酸碱平衡紊乱,全胃肠外营养以及应用抗生素.A组在常规治疗基础上应用生长抑素类似物(善宁)0.6 mg加入0.9％氯化钠溶液500 ml持续静脉滴注,同时联合置入肠梗阻导管取代普通鼻胃管行肠内减压.观察和比较4组治疗前后临床症状及体征改善情况、胃肠减压量、自主排气、排便时间和中转手术率.数据分别采用方差分析和x2检验进行分析.结果 各组平均腹痛和腹胀的缓解时间分别为3.6±1.5,5.3±1.8,5.8±1.7和8.4±2.2d (F=28.715,P=0.000);恢复排气、排便时间分别为4.5±1.9,5.7±1.4,6.0±1.1和7.8±1.7 d(F=23.857,P=0.000);A组临床症状明显改善.平均胃肠减压量分别为A组:632±102 ml/d;B组:410±86 ml/d,C组:1020±148 ml/d和D组590±97 ml/d.在C组,患者的胃肠减压量明显增加(F值分别为17.367,16.347,P=0.000),而A组则明显减少(F值分别为11.687,10.399,P=0.000).4组中转手术率分别为0(0/22),10％ (2/19),9％( 3/23)和22％ (6/27),A组中转手术率明显低于D组(x2=5.571,P=0.018).结论在常规治疗的基础上,应用生长抑素静脉持续泵入联合肠梗阻导管治疗,可加速改善粘连性肠梗阻患者的临床症状,并且提高保守治疗的成功率.     

Gallstone ileus: An analysis of 20 patients

An analysis of 20 patients with gallstone ileus treated at the University Hospital in Linköping during a 10-year period is presented. The patients had a median age of 75 years and 70% were women. The symptomatology was usually vague and consisted of diffuse abdominal pain, often accompanied by vomiting. The delay before admission to the hospital averaged 4 days. Radiography with both plain abdominal x-rays and a barium meal showed mechanical intestinal obstruction in all but 1 patient and gallstone ileus was diagnosed before laparotomy in 60% of patients. Enterolithotomy was performed in all patients but there was no surgery on the gallbladder and/or the fistula. The frequency of postoperative wound infection was 25%. There was only 1 death, a mortality rate of 5%. It is our opinion that the low mortality was due to early diagnoses, careful preoperative preparation, an operative procedure aiming only at relief of the obstruction, and improved anesthesia and prophylactive short-term antibiotics. The only indication for an elective cholecystectomy is persistent symptoms of gallbladder disease.     

A Case of Intestinal Obstruction Caused by Prominent Kyphosis Resulting in Compression of the Intestine by the Costal Arch

An 85-year-old woman with no history of abdominal surgery complained of abdominal pain and vomiting and was referred to us with a diagnosis of intestinal obstruction a few days later. Upon admission to our facility, she presented with marked abdominal swelling and prominent kyphosis. Because of the kyphosis, most of the dilated bowel was compressing her thoracic cavity. No obvious strangulation or free air was observed via abdominal computed tomography imaging. We attempted decompression using a nasogastric tube, but the symptoms persisted. Surgery was performed 2 days after admission. The origin of the obstruction was a compression of the ileocecal region by the costal arch. The bowel was discolored, and thus surgically excised. There were no major postsurgical complications other than a mild wound infection. Until now, there have been no reports of advanced kyphosis inducing ileus, but there are concerns of an increase in similar cases as society continues to age.