结肠癌术后肠梗阻影响因素分析

目的随访调查结肠癌病人术后1个月肠梗阻发生率,分析其影响因素。方法系统收集2014年10月至2016年10月解放军总医院普通外科行结肠癌根治术227例病人的临床资料,术后密切随访1个月,统计病人肠梗阻发生情况,回顾分析其可能的影响因素,运用卡方检验对单因素进行筛选,并将可能的影响因素纳入多因素非条件Logistic回归分析。结果 227例结肠癌病人术后1个月内共有19例发生肠梗阻,发生率为8.37%,经影像学、相关实验室检查及术中所见证实,19例肠梗阻病人中炎症性肠梗阻11例,机械性肠梗阻4例,麻痹性肠梗阻4例;其中年龄偏高、术前血红蛋白偏低、术前已发生肠梗阻、术前有胃肠肿物切除史、T分期偏高、左半结肠癌的病人术后1个月内肠梗阻发生率显著高于年龄偏低、术前血红蛋白在正常范围内、术前无肠梗阻、无胃肠肿物切除史、T分期偏低、右半结肠癌的病人;腹腔镜手术后1个月肠梗阻发生率显著低于开腹手术的病人,差异有统计学意义(P0.05)。多因素非条件Logistic回归分析显示,年龄(OR=1.894,95%CI:1.019~2.664)、术前肠梗阻(OR=1.894,95%CI:1.019~2.664)、T分期(OR=5.542,95%CI:2.264~8.721)是结肠癌病人术后1个月肠梗阻的危险因素,而腹腔镜手术(OR=1.894,95%CI:1.019~2.664)则是其保护因素。结论结肠癌病人术后肠梗阻发生概率较高,对于高危人群应规避风险,采取例如选择合适的术式、改善病人一般情况等必要的预防措施,避免肠梗阻的发生。     

Secondary causes of intestinal obstruction: rigorous preoperative evaluation is required

The clinical presentation, management and outcome of patients with small intestinal and large bowel obstruction unrelated to adhesive or primary colonic neoplastic disease is not well described. The aim of this study was to determine the clinical presentation, evaluation, operative management, and outcome in patients with secondary causes of intestinal obstruction. The medical records of 200 patients who underwent an operation for intestinal obstruction from January 1995 through December 1997 were reviewed. Seventy-three patients (37%) had secondary causes of intestinal obstruction, and these records were reviewed in detail. The cohort included 37 men and 36 women with a mean age of 52 +/- 2 years. The etiology of intestinal obstruction was metastatic neoplastic obstruction (19%), colonic volvulus (18%), Crohn's disease (14%), herniae (11%), diverticular disease (7%), and miscellaneous causes (31%). Six patients (8%) had intestinal motor disorders and a misdiagnosis of intestinal obstruction. The clinical presentation of patients with secondary causes of obstruction was similar to typical patients with adhesive small bowel obstruction. Preoperative evaluation included frequent use of CT (42%), but intestinal contrast studies were used in 13 (18%) patients only. Two-thirds of the patients required an intestinal resection, and 50 per cent of the patients with a misdiagnosis had a nontherapeutic celiotomy. Operative mortality and morbidity were 3 per cent and 48 per cent, respectively, and 15 per cent of patients required reoperation. Suspected intestinal obstruction from secondary causes requires rigorous preoperative evaluation with liberal use of intestinal contrast examinations to avoid misdiagnosis, operative complications, and reoperations.     

Nonoperative management of small-bowel obstruction with endoscopic long intestinal tube placement

Intestinal obstruction remains a major cause of morbidity and mortality in surgical patients. We reviewed the records of 77 patients with mechanical small-bowel obstruction who were treated with endoscopically and fluoroscopically placed Leonard long intestinal tube decompression. Most patients (59%) had failed a trial of nasogastric tube or Miller-Abbott tube decompression. Overall, 29 per cent of patients were able to resolve their obstruction with Leonard tube decompression alone. Subdivision of patients on the basis of the etiology of their obstruction demonstrated a much higher rate of success for tube decompression in adhesive obstruction (37%) versus malignant obstruction (12%) or inflammatory obstruction (no successes). Patients with radiographic and clinical evidence of complete intestinal obstruction were significantly less likely to respond to long intestinal tube treatment (13%). The long intestinal tube was easily passed in all patients. There were no complications of the intubation procedure in our series, and the incidence of tube-related complications was four per cent. We conclude that an initial period of long intestinal tube decompression allows a significant percentage of patients with mechanical small-bowel obstruction to be treated nonoperatively, particularly if a partial obstruction from postoperative adhesions is present. Patients who have failed a trial of nasogastric tube decompression and are poor operative risks should also be considered for long intestinal tube placement.     

腹壁切口疝并发肠梗阻的易感因素分析及防治措施

目的探讨腹壁切口疝并发肠梗阻的易感因素及防治措施。 方法选取2013年2月至2018年10月,甘肃省人民医院收治的52例腹壁切口疝患者为研究对象,回顾性分析其临床资料,根据患者术后是否并发肠梗阻分为发生肠梗阻组（30例）与未发生肠梗阻组（22例）。比较2组患者一般资料及围术期相关指标,筛选出肠梗阻发生的易感因素,总结其防治措施。 结果发生肠梗阻组与未发生肠梗阻组在性别、是否合并急慢性支气管炎、是否合并前列腺炎方面比较,差异无统计学意义（P<0.05）。2组在年龄、手术类型、术前营养状况、切口类型、愈合类型、合并腹水及合并便秘者方面比较,差异无统计学意义（P>0.05）。发生肠梗阻组患者经治疗后腹痛消失时间为（3.40±1.78）d、腹胀消失时间为（4.24±1.57）d、排气时间为（5.96±1.61）d、进食流质时间为（6.95±2.02）d、胃肠减压引流量为（315.21±106.52）ml/d、平均住院时间为（14.59±2.63）d。 结论腹壁切口疝并发肠梗阻的易感因素为男性、合并急慢性支气管炎或前列腺炎,但肠梗阻经及时干预治疗后患者症状及体征均得以显著改善,提示重视易感因素的控制、及早给予治疗是防治肠梗阻的关键。     

绞窄性肠梗阻108例早期诊断与手术时机的探讨

目的探讨绞窄性肠梗阻的早期诊断和手术时机。方法回顾性分析2000年1月至2008年10月间收治的108例绞窄性肠梗阻的临床资料。结果本组术前诊断绞窄性肠梗阻69例（63．9％）,其中肠坏死22例（20．4％）,余均为嵌顿疝和剖腹探查时确诊。治愈101例（93．5％）,死亡7例（6．5％）。结论早期及时采取正确的处理是提高本病治疗效果最有效手段;加强围手术期处理,积极防治并发症是降低病死率的关键。     

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目的 总结10年来肠梗阻的诊治经验。方法 回顾性分析了10年间收治的599例肠梗阻资料。结果 病因明确540例（90.2%)，其中机械性肠梗阻529例（98.0%)；原因不明59例（9.8%）。非手术治疗381例（63.6%)，手术治疗218例（36.4%)，术后并发症7例（4.5%)。死亡27例。结论 10年间肠梗阻以粘连性肠梗阻、肿瘤性肠梗阻最常见。粘连性肠梗阻中84.2%为手术后所致，青年、无手术史的肠梗阻主要为结核性粘连所致。肿瘤性肠梗阻临床表现有一定特点。对手术后早期粘连性肠梗阻应以非手术治疗为主。     

老年急性嵌顿性腹股沟疝合并肠梗阻的危险因素分析及风险列线图模型的建立

目的探讨老年急性嵌顿性腹股沟疝合并肠梗阻（POI）的危险因素及风险列线图模型的建立,为临床护理工作提供参考依据。 方法回顾性分析2012年6月至2018年6月因急性嵌顿性腹股沟疝于我院就诊的259例老年患者的临床资料。按照是否并发POI,分为并发POI组和非POI组。分别使用单因素和Logistic回归多因素分析老年急性嵌顿性腹股沟疝合并发肠梗阻的独立危险因素。然后纳入筛选出的独立危险因素建立列线图预测模型,并对模型的预测性及准确度进行验证。 结果2组患者性别、文化程度、身体质量指数、高血脂、高血压、冠心病、吸烟史、酗酒史、术前贫血和手术时间等信息的比较,均无统计学差异（χ²=0.239,0.324,0.179,0.485,0.282,0.069,0.402,0.146,0.108,0.994;P>0.05）,而年龄、糖尿病、恶性肿瘤、腹部手术史、嵌顿时间和术后感染等资料差异有统计学意义（χ²=5.963,9.954,17.644,17.281,9.154,8.831;P<0.05）。以并发POI情况为因变量,以并发POI组和非POI组单因素分析中有统计学意义的6个项目（年龄、糖尿病、恶性肿瘤、腹部手术史、嵌顿时间、术后感染）为自变量,进行多元Logistic回归分析,结果表明,年龄、糖尿病、恶性肿瘤、腹部手术史、嵌顿时间及术后感染是老年急性嵌顿性腹股沟疝并发POI的独立危险因素,具有统计学差异（OR=3.515,4.506,8.805,17.526,3.937,2.770,0.015;95% CI：1.437～8.601,1.519～13.372,2.349～33.011,3.986～77.067,1.615～9.598,1.147～6.686;P<0.05）,均与老年急性嵌顿性腹股沟疝并发POI高度相关。基于年龄、糖尿病、恶性肿瘤、腹部手术史、嵌顿时间和术后感染这6项老年急性嵌顿性腹股沟疝并发肠梗阻的独立危险因素,建立预测老年急性嵌顿性腹股沟疝并发肠梗阻的列线图模型,经验证,其预测值同实测值基本一致,说明本研究的列线图预测模型具有较好的预测能力,同时本研究该列线图模型使用Bootstrap进行内部验证法,C-index指数高达0.846（95% CI：0.812~0.880）,模型对于老年急性嵌顿性腹股沟疝并发POI诊断的ROC也高达0.846,说明本研究列线图模型具有良好的精准度和区分度。 结论老年急性嵌顿性腹股沟疝并发肠梗阻的风险较高,年龄、糖尿病、恶性肿瘤、腹部手术史、嵌顿时间和术后感染是老年急性嵌顿性腹股沟疝并发肠梗阻的独立危险因素,相关列线图预测模型的建立能够提高对老年急性嵌顿性腹股沟疝并发肠梗阻的诊断效能,为进一步优化护理模式提供方向,临床应用价值较高,值得进一步推广使用。     

肠梗阻188例临床分析

目的 探讨肠梗阻的治疗方法.方法 回顾性分析2005年7月至2008年7月我院普外科收治肠梗阻188例的临床资料.结果 188例中行非手术治疗治愈82例;行手术治疗106例,死亡6例.本组治愈率为97.8 %.结论 本组病例肠梗阻的首要原因仍然是肠粘连,采用生长抑素及灌肠治疗粘连性肠梗阻有效.小容量生理盐水加开塞露灌肠治疗肠梗阻是安全有效的.应用生长抑素,可迅速改善临床症状.     

腹腔镜治疗老年结直肠癌术后肠梗阻对血清肌酸激酶和D-二聚体的影响

目的对比分析腹腔镜与开腹手术治疗老年结直肠癌术后早期肠梗阻的发生情况以及血清肌酸激酶（CK）和D-二聚体（D-dimer）的变化意义。 方法回顾性分析广安市人民医院2014年1月至2017年1月诊治的130例老年结直肠癌患者临床资料,分析患者经腹腔镜治疗（腹腔镜组,60例）和常规开腹手术治疗（开腹组,70例）后肛门排气时间、住院天数和肠梗阻的发生率,并采用肌酸显色法检测不同手术患者治疗前后血清CK水平变化,酶联免疫吸附测定法检测两组治疗前后D-dimer的水平变化。 结果（1）与开腹组相比,腹腔镜组患者左半结肠癌根治术、右半结肠癌根治术和直肠癌根治术的手术时间及术中出血量明显降低,术后肛门排气时间及住院天数均明显缩短,肠梗阻总发生率明显降低（均P<0.05）。（2）腹腔镜组术后发生肠梗阻4例（6.7%）,开腹组术后发生肠梗阻13例（18.6%）,腹腔镜组患者肠梗阻总发生率以及左半结肠癌根治术后肠梗阻发生率较开腹组明显降低,差异有统计学意义（χ²=4.028、4.409,P=0.045、0.036）。（3）治疗后两组患者血清CK和D-dimer水平均明显降低,且腹腔镜组治疗后CK和D-dimer水平均显著低于开腹组,差异有统计学意义（P<0.01）。（4）肠梗阻患者CK和D-dimer水平显著高于未发生肠梗阻患者的水平,差异有统计学意义（t=9.235、13.877,均P<0.01）。（5）肠梗阻患者CK和D-dimer水平变化呈明显正相关性（r=0.852,P=0.012）。 结论老年腹腔镜结直肠术后肠梗阻发生率低,患者术后恢复更快,检测血清CK和D-dimer水平降低程度可以为临床更合理的治疗提供参考。     

绞窄性肠梗阻的早期诊断与手术时机（附108例报告）

目的探讨绞窄性肠梗阻的早期诊断和手术时机。方法回顾性分析我院2000年1月至2008年10月间收治的108例绞窄性肠梗阻的临床资料。结果本组术前诊断绞窄性肠梗阻69例（63．9％）,其中肠坏死34例（31．4％）,余均为嵌顿疝和剖腹探查时确诊。治愈101例（93．5％）,死亡7例（6．5％）。结论早期及时采取正确的处理是提高本病治疗效果最有效手段。加强围手术期处理,积极防治并发症是降低病死率的关键。     

小肠内置管排列术治疗放射性肠炎合并肠梗阻

目的：探讨小肠内置管排列术治疗放射性肠炎合并肠梗阻的临床效果。方法：对12例放射性肠炎合并肠梗阻的患者进行小肠内置管排列术，其中2例行病变肠段切除，一期肠吻合术，其余10例行捷径手术，病变肠段旷置术。结果：全部临床治愈，主要并发症为肠瘘（25％）、腹腔感染（16．7％）。结论：放射性肠炎合并肠梗阻需手术治疗，捷径手术＋小肠内置管排列术是有效的手术方式，围手术期积极的营养支持是手术成功的保证。     

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??Long-term follow-up following nonsurgery for early postoperative inflammatory intestinal obstruction LI You-sheng,LI Min,LI Ning, et al. Department of Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China
Corresponding author: LI You-sheng, E-,mail: liys@medmail.com.cn
Abstract Objective To examine the results of treatment for the early postoperative inflammatory intestinal obstruction and long-term follow-up. Methods A retrospective analysis of 121 patients with early postoperative inflammatory intestinal obstruction from January 1999 to December 2008 was undertaken. Patients’ medical records were reviewed in their entirety. A systematic follow-up was carried out and ended in March 2009. The primary endpoint and secondary endpoint of the study were surgery and the recurrence rate of intestinal obstruction caused by intra-abdominal adhesions. Results All patients were treated conservatively. The follow-up period was 2-116??43.23±12.75?? months. Overall, 14(11.57%) of the 121 patients had recurrent episodes of intestinal obstruction and 6 patients (4.96%) had a least a admission. No patient had undergone operation for intestinal obstruction.Conclusion Non-operative treatment for early postoperative inflammatory intestinal obstruction has a lower cumulative recurrence rate following a long-term follow-up. Operative treatment is not deemed necessary.     

Diagnosis and treatment of acute adhesive small intestine obstruction

Experience of treatment of 162 patients with acute adhesive intestinal obstruction (AAIO) is described. These patients had most often (23.3%) appendectomy in anamnesis. Conservative treatment was effective in 23 (14.2%) patients only. Surgical treatment was performed in 139 (85.8%) patients including traditional open operation in 79 (56.8%) patients, laparoscopic and laparoscopy-assisted in 60 (43.2%). Advanced adhesive process with formation of single intestinal conglomerate, neglected forms of AAIO with paralytic ileus were indications to open operations; lethality in these operations was 17.7%. Laparoscopic operation was indicated in AAIO due to isolated commissure as well as in early adhesive obstruction; lethality was 1.7%. If diagnostic laparoscopy showed that AAIO is caused by intestinal deformation in small intestinal conglomerate or intestinal resection is required, laparoscopy-assisted operations were performed.     

Diagnosis and treatment of adhesive intestinal obstruction in children

The work analyses 455 patients with acute adhesive intestinal obstruction (194 children with the early and 261 with the advanced stage of the disease). The most common causes of the obstruction were acute appendicitis, developmental anomalies of the intestine, and intestinal intussusception. Complete viscerolysis and horizontal intestinoplication by means of medical glue without application of sutures were performed in a total adhesion process, even in the acute period (34 cases). Severe paresis or paralysis of the gastrointestinal tract is an indication for its decompression. Laparoscopy was conducted in 90 children (from 3 months to 14 years of age) in suspected acute adhesive intestinal obstruction. The diagnosis was confirmed or defined more exactly in 64 patients. As the result of endoscopic operations intestinal obstruction was corrected and laparotomy was avoided in almost half of the patients. The total mortality was 1.3%.     

腹部手术后早期肠梗阻42例临床分析

目的探讨腹部手术后早期肠梗阻的诊断和治疗措施。方法回顾性分析42例腹部手术后早期肠梗阻的临床病例资料。结果42例患者全部治愈。其中31例腹部术后早期炎性肠梗阻及8例麻痹性肠梗阻采用非手术疗法,平均治愈时间为10．3d,无一例发生肠绞窄。3例机械性肠梗阻采用手术治疗,平均治愈时间为16．5d。结论腹部术后早期炎性肠梗阻及麻痹性肠梗阻采取以非手术治疗为主的治疗方案,可缩短治疗时间,减少并发症,从而达到良好的临床效果。对于少数存在机械性肠梗阻的患者,应及时手术治疗。依据肠梗阻类型选择合理的治疗方法,准确掌握手术指征是治疗术后早期肠梗阻的关键。     

Contrast radiography in small intestinal obstruction, a valuable diagnostic tool?

OBJECTIVE: To investigate the diagnostic and therapeutic potential of plain abdominal radiographs and contrast radiography in patients with suspected small intestinal obstruction. DESIGN: Retrospective study. SETTING: General hospital, Sweden. MATERIAL: 2357 sets of plain abdominal radiographic casenotes. MAIN OUTCOME MEASURES: Analysis of plain abdominal radiographs for small intestinal obstruction. Establishment of the time that subsequent contrast radiography medium took to reach the caecum, and its success rate. RESULTS: Of the 2357 plain abdominal films 1599 (68%) did not show small intestinal obstruction, 425 (18%) showed intermediate obstruction, and 333 (14%) showed small intestinal obstruction. The water-soluble contrast medium reached the colon in 394/591 (67%) of the cases with intermediate or complete small intestinal obstruction. Although the contrast medium passed to the colon there was remaining abnormality with dilated small intestine in 71/212 (33%) of the cases with intermediate obstruction and in 95/143 (66%) of the small intestinal obstruction group. The time for the contrast medium to reach the colon was 3.4 hours in the normal group, 5.5 hours in the intermediate group and 8.9 hours in the obstruction group. CONCLUSION: The plain abdominal radiographs seem to predict the success of follow-through examinations. Contrast radiography is safe and may have a therapeutic potential in small intestinal obstruction.     

腹腔镜与开腹手术治疗结直肠癌疗效比较

目的探讨腹腔镜与开腹手术治疗结直肠癌的手术效果。方法把62例结直肠癌患者随机分为常规开腹手术组(常规组)和腹腔镜下结直肠癌手术组(观察组)各31例。观察两组患者术后肛门排气时间、住院天数和肠梗阻的发生率,并对疗效进行评价。结果观察组患者术后肛门排气时间和住院天数均显著少于常规组。常规组20例结肠癌术后有6例发生肠梗阻,发生率为30.0%,观察组22例结肠癌术后有1例发生肠梗阻,发生率为4.55%。常规组11例直肠癌术后有2例发生肠梗阻,发生率为18.18%,观察组9例直肠癌术后有1例发生肠梗阻,发生率为11.11%。结论腹腔镜下结直肠癌手术创伤小,术后恢复快,肠梗阻的发生率较少。     

慢性放射性肠炎并发肠梗阻的治疗

目的探讨放射性肠炎并发肠梗阻的治疗方法及临床效果。方法对2001年8月至2006年12月间收治的51例慢性放射性肠炎并发肠梗阻患者的临床资料进行总结。结果本组患者放射性肠炎并发肠梗阻均为肿瘤切除后盆腔、腹腔接受放射治疗所致,从放疗结束到肠梗阻症状出现的时间为(11.9±22.6)个月。分别采用了保守治疗(方案包括禁食、胃肠减压、抑制消化液分泌、营养支持、灌肠、补液、对症等,对于有感染征象的患者选用敏感的抗生素)、肠切除吻合术、肠造口术及短路手术。2例患者因肿瘤广泛转移未行有效手术治疗,1例患者术后因腹腔出血死亡,48例患者得到治愈,治愈率达94.1%。结论慢性放射性肠炎并发肠梗阻的治疗方案应该根据患者的营养状况及肠管损伤情况进行选择。     

迷你腹腔镜治疗小儿粘连性肠梗阻

目的 评价迷你腹腔镜治疗小儿粘连性肠梗阻的临床意义。方法 2001年3月至2004年1月，应用迷你腹腔镜行肠粘连松解术治疗粘连性肠梗阻18例，并对其临床资料进行分析。结果 本组病例手术时间15～45(平均30)min；术后第1天下床活动；术后肛门排气时间12～28(平均22)h；术后第2天开始进食，3～5(平均4)d痊愈出院，均无并发症发生。随访3～18个月，全组术后恢复良好，均无复发。结论 选择性地应用迷你腹腔镜，行肠粘连松解术治疗小儿粘连性肠梗阻，操作简单，疗效安全可靠。