术后早期炎性肠梗阻23例诊治分析

目的 探讨术后早期爽性肠梗阻的临床特点、诊断、治疗和预防。方法 对23例早期炎性肠梗阻的治疗结果进行回顾性分析。结果 23例患者经胃肠减压、应用生长抑素、肠外营养、肾上腺皮质激素等疗法治愈，平均95d，无一例2次手术。结论 术后早期炎性肠梗阻常发生于术后4～11d，有典型的临床特点，保守治疗可治愈。     

术后早期炎性肠梗阻的诊断与治疗

目的 探讨术后早期炎性肠梗阻的特点和诊断，治疗原则。方法 分析近期经治的术后早期炎性肠梗阻23例。结果 23例病人均经胃肠减压，应用生长抑素，肾上腺皮质激素及肠外营养等治疗后痊愈，平均治愈时间13.2天，无一例再手术引起；（3）症状以腹胀为主，腹痛相对较轻；（4）很少发生肠绞窄。（5）最好先试行保守治疗2-4周，多数有效。     

术后早期炎性肠梗阻32例临床分析

目的 探讨术后早期炎性肠梗阻的诊断和治疗方法.方法 对32例术后早期炎性肠梗阻的临床特点和治疗方法进行回顾性分析.结果 32例患者均经胃肠减压、应用生长抑素、肾上腺皮质激素、肠外营养、抗生素等方法治愈,平均住院时间15d,无一例肠坏死.结论 术后早期炎性肠梗阻的特点①发生于腹部手术后早期.②症状以腹胀为主,疼痛相对轻,部分患者排便、排气,体征典型,但较少发生绞窄.③保守治疗大多有效,过程中应严密观察,如出现肠坏死、腹膜炎时及时中转手术.     

术后早期炎性肠梗阻67例诊治分析

目的 探讨术后早期炎性肠梗阻(EPISBO)的诊断和治疗方法.方法 回顾性分析2000年1月至2007年10月收治的67例EPISBO的临床资料.结果 有64例经非手术治疗治愈;3例经非手术治疗5～7 d后中转手术,2例治愈,1例发生肠瘘后死亡.结论 术后早期炎性肠梗阻好发于腹腔污染重或创伤大的腹部手术,多发生于术后3周以内,有典型的肠梗阻症状和体征,诊断主要依靠病史、体征及腹部X线、CT检查,应先采取非手术治疗,要严格掌握再手术适应证.     

术后早期炎性肠梗阻64例诊治分析

目的 探讨术后早期炎性肠梗阻的临床特点及处理方法。方法 分析64例术后早期炎性肠梗阻的病例资料。结果 64例均行禁食、胃肠减压、应用生长抑素、肠外营养等支持治疗，平均治愈时间13.5d，无一例再手术。结论 术后早期炎性肠梗阻多发性于术后5-15d，可表现为典型的肠梗阻征象，多由小肠无菌性炎症致广泛肠粘连所致，多数病例采用保守疗法可治愈。     

术后早期炎性肠梗阻32例诊治体会

术后早期炎性肠梗阻(early postoperative inflammatory small bowel obstruction,EPISBO) 在临床上属常见并发症,由于外伤、手术创伤或腹腔内炎症等导致肠壁水肿和渗出而形成的一种机械性与动力性同时存在的粘连性肠梗阻,炎症指无菌性炎症[1].     

术后早期肠梗阻的诊治体会

术后早期肠梗阻是指术后30d内，肠蠕动恢复后再次出现腹痛、呕吐等症状，影像学检查存在肠梗阻证据。术后早期肠梗阻作为机械性肠梗阻的特殊类型，在肠梗阻的治疗中具有重要地位。本文总结开腹手术后早期肠梗阻的类型及诊治，得出了一些经验和教训，报告如下。     

术后早期炎性肠梗阻18例诊治分析

目的 探讨术后早期炎性肠梗阻的临床特点及处理方法.方法 分析18例术后早期炎性肠梗阻的临床特点及治疗结果.结果 18例均胃肠减压,应用生长抑素、肠外营养等支持疗法,平均治愈时间为17 d,1例因切口裂开再手术并发小肠瘘.结论 术后炎性肠梗阻多发生在术后5～7 d,可表现为典型的肠梗阻体征,多由小肠无菌性炎症致广泛肠粘连引起,多数病例采用保守疗法可治愈.     

术后早期炎性肠梗阻13例诊治体会

目的总结术后早期炎性肠梗阻的诊治经验。方法回顾13例炎性肠梗阻病人的治疗方法，包括禁食，胃肠减压，全肠外营养，生长抑素和糖皮质激素的应用，中医治疗。结果13例病人中12例治愈，平均治疗时间28d，一例治疗三周后转入上级医院。结论采用非手术治疗术后早期炎性肠梗阻效果满意，并发症少，安全。     

腹部术后早期炎性肠梗阻的诊治

目的 探讨腹部手术后早期炎性肠梗阻的诊断及治疗.方法 回顾性分析腹部手术后早期炎性肠梗阻22例.结果 22例患者经胃肠减压、营养支持及使用生长抑素、肾上腺皮质激素等综合保守治疗,所有患者均治愈.结论 早期炎性肠梗阻宜采用非手术治疗.     

Non-traumatic perforation of the small bowel

Background

Non-traumatic perforation of the small bowel is an uncommon serious complication associated with high morbidity and mortality. Diseases that cause small bowel perforation vary in different areas of the world.

Objective

To highlight difficulties in the diagnosis and management of non-traumatic perforation of small bowel.

Material and methods

The medical records of four patients who have presented with non-traumatic perforation of the small bowel and were treated at Al-Ain Hospital during the last 5 years were studied retrospectively.

Results

The presenting symptoms of all patients were similar. Erect chest X-ray has shown free air under diaphragm in 3 patients. Leukocytosis was present in only one patient. HIV was confirmed in one patient. Patients were diagnosed to have typhoid, HIV, hook worms and tuberculosis. Only the HIV patient died while the others were discharged home in a good condition.

Conclusion

Clinical findings of small bowel perforation are usually non specific and diagnosis is usually reached after surgery. The Histopathological examination of the small bowel ulcer were non conclusive in three patients. We have made our management plan according to the clinical findings. Non traumatic perforation in developing countries can be due to typhoid, HIV, tuberculosis and possibly hook worms.     

腹腔镜在小肠梗阻中的临床应用价值

目的探讨腹腔镜在小肠梗阻中的临床应用价值。方法回顾性分析接受腹腔镜治疗的小肠梗阻患者32例,男11例,女21例,年龄19—91岁,平均60．3岁。其中22例有腹部手术史。采用腹腔镜探查梗阻原因,解除梗阻病灶,恢复肠管通畅。结果本组患者术后粘连22例,小肠问质瘤3例,粪石梗阻2例,急性阑尾炎2例,肠套叠1例,假性肠梗阻2例,腹腔镜诊断准确率为93．8％（30／32）。全腹腔镜手术治疗15例,病变局部区域小切口辅助腔镜治疗8例,中转开腹9例。平均手术时间40min（25～160min）,无腔镜手术相关死亡。平均住院天数4．2d。随访12—36个月,无小肠梗阻复发。结论对于梗阻原因不明,保守治疗无效的小肠梗阻来说,腹腔镜是一种安全有效的诊断和治疗手段,但血流动力学不稳、腹胀明显,合并内科严重心脑肺部疾病的患者视为腔镜手术禁忌。对手术中显露困难,粘连广泛,脏器损伤的患者仍需中转开腹。     

Solitary fibrous tumor of small bowel mesentery with postoperative bowel obstruction: a case report and review of literature

Solitary fibrous tumor (SFT) which is an extremely rare clinical entity has been reported infrequently. Most commonly it is distinguished into pleural and extrapleural forms, with same morphological resemblance. There has been many literatures reported regarding extrapleural form of SFT but few cases of SFT originating from small bowel mesentery have been reported till now. We here report one case of SFT of small bowel mesentery with some eventful postoperative bowel obstruction and literature review.     

手术治疗绞窄性肠梗阻81例临床体会

目的探讨绞窄性肠梗阻的早期诊断及有效的手术治疗方法。方法回顾性分析经手术治疗81例绞窄性肠梗阻的临床资料。结果术前确诊为绞窄性肠梗阻者有59例(72.8%),且大多数为肠坏死;其余22例(27.2%)则分别以单纯性肠梗阻或其他急腹症行剖腹探查而确诊。本组均行手术治疗,治愈76例;死亡5例,死亡率为6.17%。其主要死亡原因是感染中毒性休克、多脏器功能衰竭及严重水电解质紊乱及酸碱失衡。结论绞窄性肠梗阻早期诊断较困难,应根据临床特点和辅助检查,严密观察其动态变化,综合分析判断,把握手术时机,预防肠坏死的发生,早期诊断及时进行手术治疗是提高救治成功的关键。     

Pediatric inflammatory bowel disease: specificity of very early onset

Introduction: The incidence of inflammatory bowel disease (IBD) has increased over the last 50 years. It is now recognized that several genetic defects can express an IBD-like phenotype at very early onset (<6 years).

Areas covered: The aim of this review was to update knowledge concerning the specificity of IBD at onset <6 years, which can include conventional/standard IBD as well as monogenic IBD-like diseases.

Expert commentary: We found that females are less prone than males to develop monogenic disorders, which have X-linked heritability in several cases. Furthermore, the Crohn’s Diseases (CD) subtype seems to be suggestive of monogenic disorders while Unclassified IBD (IBDU) subtype is predominantly found in conventional/standard IBD at onset <6 years. Isolated colonic location is prevalent in both the subsets of IBD at onset <6 years if compared to IBD at later onset. Monogenic disorders require more aggressive medical and surgical treatments and can be complicated by the occurrence of lymphomas.     

Very early onset inflammatory bowel disease: Investigation of the IL-10 signaling pathway in Iranian children

Background & aimComparing to adult inflammatory bowel disease (IBD), those with early onset manifestations have different features in terms of the underlying molecular pathology, the course of disease and the response to therapy. We investigated the IL-10 signaling pathway previously reported as an important cause of infantile (Very Early Onset) IBD to find any possible variants.MethodWith the next generation sequencing technique we screened IL-10, IL-10RA and IL10RB genes of 15 children affected by very early onset-GI (gastrointestinal) disorders. Additionally, we analyzed them based on Thermo Fisher immune deficiency panel for genes either having a known role in IBD pathogenesis or cause the disorders with overlapping manifestations. We performed multiple functional analyses only for the cases showing variants in IL-10- related genes.ResultIn 3 out of 15 patients we identified variants including a homozygous and heterozygote mutations in IL-10RA and a novel homozygous mutation in IL-12RB1. Our functional studies reveal that in contrast to the IL-10RA heterozygote mutation that does not have deleterious effects, the homozygous mutation abrogates the IL-10 signaling pathway.ConclusionOur study suggests we need to modify the classical diagnostic approach from functional assays followed by candidate- gene or genes sequencing to the firstly parallel genomic screening followed by functional studies.     

青光眼小梁切除术后滤道阻滞的早期手术治疗

目的探讨小梁切除术后滤道阻滞的处理方法。方法回顾分析25眼术后1个月内发生滤道阻滞患者临床资料,根据小梁切除术后滤道阻滞不同部位,在术后1个月内切口粘连不紧密时,内部阻滞的患者通过缩瞳、角膜侧切口将前粘连的虹膜周切口分离,必要时扩大虹膜周切口,恢复周边前后房的交通;中部阻滞的患者重建小梁切口,确保其通畅;外部阻滞的患者术后1个月内结膜瓣、巩膜瓣剥离。结果眼压下降与术前眼压比较,差异显著。观察6~12个月,眼压稳定在13~21 mmHg。结论小梁切除术术后1个月内,切口粘连并不十分紧密,采取适当的措施是可以恢复滤过功能的。