小肠悬挂排列术治疗广泛粘连性肠梗阻

目的探讨小肠悬挂排列术治疗广泛粘连性肠梗阻的手术经验。方法1990年2月至2006年2月对术中诊断为广泛粘连性肠梗阻的27例患者行小肠悬挂排列术。结果本组27例痊愈,获随访15例,随访时间3个月至12年,无因粘连性肠梗阻而再次入院手术者。结论小肠悬挂排列术是预防广泛粘连性肠梗阻再发的有效术式。     

小肠内支撑排列术治疗多次术后广泛粘连性肠梗阻

目的总结小肠内支撑排列术治疗多次术后广泛粘连性肠梗阻的临床经验与疗效。方法回顾分析1995～2003年间采用小肠内支撑排列术治疗多次术后广泛粘连性肠梗阻21例患者的临床资料。结果20例患者术后无并发症发生,顺利康复。1例肠坏死肠切除病例术后发生肠瘘,经内支撑管持续低负压引流后迅速痊愈。19例患者经1～7年随访,均未出现肠粘连和肠梗阻。结论对多次手术(2次以上)后出现广泛粘连性肠梗阻患者,小肠内支撑排列术是一种操作简单、安全而有效的术式。     

小肠内置管排列术治疗重症粘连性肠梗阻16例临床分析

目的探讨小肠内置管排列术治疗重症粘连性肠梗阻的方法及效果。方法选择16例重症粘连性肠梗阻患者行肠粘连松解及小肠内置管排列术治疗,对患者的临床资料进行回顾性分析。结果 16例均顺利完成手术,术后2~3周逐渐分段拔除小肠排列管,康复出院。全部患者均获经1~4 a随访,无肠梗阻复发病例。结论严格掌握手术适应证,规范进行手术操作及精心的术后处理,小肠内置管排列术是重症粘连性肠梗阻的有效治疗和预防术式。     

粘连性肠梗阻手术治疗方法探讨

目的 探讨粘连性肠梗阻手术治疗方法及临床效果.方法 回顾分析我院普外科2002年2月至2007年5月收治的107例因粘连性肠梗阻手术治疗病人的临床资料,总结分析手术治疗方法及临床效果.结果 全组病例开腹粘连松解或肠切除吻合术53例,术后随防6个月～3年,再发肠梗阻手术9例,占16.9%.粘连松解后行M-A支撑管内排列术19例,术后随防6个月～2年,无一例因肠梗阻再次手术.近期开展的腹腔镜下粘连松解术35例,术后随防3个月～2年,均无梗阻症状复发.全组病例全部治愈,无肠瘘发生.结论 粘连性肠梗阻急诊手术以开腹粘连松解或肠切除手术为主.腹腔多次手术,粘连广泛者,采用支撑管内排列术可以有效预防粘连性肠梗阻的再发生.对于选择性病人,腹腔镜下粘连松解术是一种创伤较小,安全可靠的方法.     

小肠置管排列防治粘连性肠梗阻

粘连性肠梗阻是外科常见疾病,在处理上比较复杂,尤其是反复发作或经过多次手术者治疗更感困难。我院自1965～1984年,对37例粘连性肠梗阻患者,应用小肠置管排列术,获得较满意的效果,现报道如下。临床资料37例中,男25例,女12例。年龄最大者63岁,展小者15岁,25～55岁者28例(占70%)。全组既往有手术史者31例,其中经过1次手术者6例,2次者15例,3次者8例,4次和5次者各1例,另4例为粘连性肠梗阻初次手术,该4例过去有腹膜炎病史,经保守治愈。还有2例为外伤性肠穿孔,肠壁广泛挫伤。为了预防粘连性肠梗阻,也应用了小肠置管排列术。全组无手术死亡病例。术后随访:失访者6例,     

小肠插管内固定排列术治疗广泛粘连性完全性肠梗阻

目的探讨小肠插管内固定排列术治疗广泛粘连性完全性肠梗阻的效果。方法对31例广泛粘连性完全性肠梗阻患者行肠粘连松解及小肠插管内固定排列术,回顾性分析患者的临床资料。结果所有患者均康复出院,随访2~5年,无1例出现不完全肠梗阻症状。结论采用小肠插管内固定排列术治疗广泛粘连性完全性肠梗阻,方法简单、并发症少、疗效确切,远期效果好,值得临床进一步完善推广。     

腹腔镜下肠粘连松解术16例临床分析

目的探讨治疗粘连性肠梗阻的新方法。方法对因粘连性肠梗阻行腹腔镜下肠粘连松解术16例病人进行回顾性分析。结果手术成功率是87.5%(14/16)。2例失败由于腹腔广泛严重粘连而中转剖腹行粘连松解及小肠折叠术。平均手术时间是58mins;术中出血量为20ml～100ml。术后平均住院3天,无手术死亡及其它手术后并发症。结论腹腔镜下肠粘连松解术具有创伤小,术后恢复快,手术后并症少,住院时间短等优点。它为粘连性肠梗阻治疗提供一种新方法。它的手术指征是单纯性不完全性粘连肠梗阻及症状反复发作。     

经鼻导管小肠排列术治疗小儿重症粘连性肠梗阻

目的评价经鼻导管小肠内排列术在治疗小儿外科中粘连性肠梗阻的应用选择和临床疗效。方法回顾性分析2006—2011年26例重症粘连性肠梗阻行经鼻导管内支架肠排列术的临床资料,与同期26行传统内支架排列术作为对照研究。结果所有患儿均有开腹手术病史。26手术均手术成功,均行经鼻导管内支架小肠排列术,23例康复出院,死亡3例,病死率为11.5%。死亡原因,肠瘘1例,爆发性感染1例,心肺衰竭1例。拔管顺利,拔管后仅有轻度呕吐4例,无其他不良反应。23例全部随访2～6 a,无远期梗阻复发。结论经鼻导管内支架小肠排列术是治疗患儿腹腔严重粘连的有效治疗和预防方法,可以选择性应用。     

全小肠排列法治疗粘连性肠梗阻的体会

我院自1961～1980年采用全小肠排列术治疗反复发作的粘连性肠梗阻,或其它原因肠壁广泛损伤共53例。经术后随访观察,认为效果尚满意,报告如下。临床资料本组男41例,女12例。年龄最大58岁,最小6岁。53例中曾有腹部手术史,后发生急性粘连性肠梗阻,经非手术治疗无效者34例;因闭合性腹外伤肠壁损伤严重者4例;结核性腹膜炎致肠管广泛粘连发生急性梗阻6例;腹腔内严重感染,包括手术后腹腔内多发性残余脓肿形成9例。效果:本组有3例因绞窄性肠梗阻并发中毒性休克治疗无效死亡。术后失去联系14例。余36例均进行1～20年随访。随访病例绝大部分饮食、消化、排泄功能正常。儿童患者术后发育良好,仅有个别病例偶尔发生不规则的腹部胀痛(多与进食不当或剧烈运动有关)或下腹坠痛。     

肠系膜穿线法小肠排列术治疗粘连性肠梗阻

肠系膜穿线法小肠排列术治疗粘连性肠梗阻郑瑞华，杨英起广泛粘连性肠梗阻常见，但处理困难，因反复梗阻手术疗效差。我院对１８例广泛粘连致反复肠梗阻患者施行了肠系膜穿线法小肠排列术疗效显著，再未梗阻，现报告如下：本组１８例，男１４例，女４例，最小１０岁，最大...     

Comparison of Urografin versus standard therapy in postoperative small bowel obstruction.

Water-soluble contrast media (Urografin) cause redistribution of intravascular and extracellular fluid into intestinal lumen due to their hyperosmolarity. As a consequence, these media decrease intestinal wall edema and act as a direct stimulant to intestinal peristalsis. In this prospective study, we aimed to examine objectively the therapeutic role and ability of Urografin in patients with postoperative small bowel obstruction for whom failed to respond to conservative treatment. Three hundred and seventeen patients with postoperative small bowel obstruction due to intraperitoneal adhesions were included prospectively in this study. In the Urografin group, 40 mL Urografin diluted in 40 mL distilled water was administered through the nasogastric tube. No contrast media were administered in the control group, but the patients were decompressed via a nasogastric tube continuously. The number of obstruction episode in 317 patients was 338. In total, 199 patients were in the Urografin group, and 118 patients were in the control group. In the Urografin group, 178 (89.4%) patients responded successfully to the treatment, but 21 (11.6%) patients underwent surgical operation. Intensive intraabdominal adhesions and obstructing fibrous bands were observed and repaired in 15 (71.4%) patients at the operation, while 6 patients underwent segmental small intestine resection in control group, conventional management was successful in only 89 (75.4%) patients, and the remaining 29 (24.6%) patients underwent surgical intervention. In conclusion, it was suggested that in patients with intestinal obstruction due to postoperative intra-abdominal adhesion, water-soluble contrast media such as Urografin may be safely administered via a nasogastric tube or oral route and may decrease the need for surgical operation; furthermore, they may help the physician to operate the patients who needs surgery as early as possible.     

Laparoscopic treatment of acute small bowel obstruction*

BACKGROUND: Symptoms of obstruction in the intestinal tract involve the small intestine in three quarters of cases and the large intestine in one-quarter. The most common causes of an acute small intestinal obstruction are postoperative adhesions (64.8%) and strangulated hernias (14.8%). The overall incidence of postoperative small bowel obstruction is 4.6%. Because it offers a conservative and targeted means of removing the obstruction, laparoscopy is increasingly used for acute small bowel obstruction. With proper selection of patients, the success rate is very high. This work presents the selection criteria, technique and results for a three-year period. METHODS: Twenty-one patients, 13 men and 8 women aged 28 to 69 years, underwent surgery between January 2008 and December 2010. Selection criteria for a laparoscopic procedure were anesthesia risk of not more than ASA 3, diameter of the dilatated loop of small intestine of not more than 5 cm, radiological image of a change in caliber as an indication of a focal passage disorder, exclusion of paralytic ileus, and no history of diffuse peritonitis. The patients underwent surgery in general anesthesia. The approach for the first trocar was umbilical in 18 cases and in the right or left flank in three cases, but always with open technique. Three trocars were always used. RESULTS: In 7 patients, there was an isolated band from a previous operation, usually an appendectomy; in 5 cases there were postoperative adhesions and a band. Three patients had a volvulus and in one of them, a 20 cm segment of the small intestine was already gangrenous. Two patients had an incarcerated hernia, one inguinal and one Bochdalek. Two patients had a stenosing tumor in the terminal ileum, one of which was a carcinoid and the other, the first manifestation of a lymphoma. One patient had an endometriosis focus as stenosis focus and another had a massively inflamed Meckel's diverticulum that obstructed passage in the small intestine. Two patients – the volvulus with small intestinal gangrene and the Bochdalek hernia – required conversion to open technique. One patient with diffuse adhesions and a band had to undergo open surgery 10 days later. There was no case of an intraoperative accidental intestinal injury. All the patients who underwent laparoscopy were discharged within a week. Hospitalization was significantly longer for the converted patients. The patient with the Boachdalek hernia died after 26 days of irreversible cardiopulmonary failure. CONCLUSIONS: With strict selection, laparoscopic treatment of small intestinal obstruction is a valuable option in visceral acute surgery. Patients with an isolated focal obstruction seem to benefit from laparoscopic surgery on the basis of reduced perioperative morbidity and short hospitalization.     

NASOGASTROINTESTINAL INTRALUMINAL TUBE STENTING IN THE PREVENTION OF RECURRENT SMALL BOWEL OBSTRUCTION

Nasogastrointestinal intraluminal tube stenting using a Dennis tube (Sherwood Medical St Louis, Missouri, USA) was performed on 25 patients. Two intubations were for midgut volvulus, 13 for small intestinal obstruction after extensive adhesolysis, and 10 as an adjunct to the operative management of enterocutaneous fistulae following extensive adhesolysis, resection and anastomosis. No patient developed recurrent small bowel obstruction for periods up to three years after operation. Use of an intraluminal tube stent in preventing recurrent small bowel obstruction due to adhesions is safe and effective when used on appropriately selected patients. Its effectiveness should be more widely recognized.     

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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。     

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目的 总结65岁以上(老年组)和14岁以下(少年组)肠梗阻病人急诊手术指征及术中、术后处理。方法 回顾分析1998—2003年经治的202例肠梗阻病人资料，72例急诊手术中老年组和少年组共29例。结果 非手术治疗130例(64．36％)，急诊手术治疗72例(35．64％)，老年组和少年组占急诊手术的40．27％。术后粘连引起的肠梗阻47例(65．30％)。老年组肿瘤4例(19．05％)，术后死亡3例(14．28％)。结论 4年间肠梗阻以粘连性肠梗阻、肿瘤性肠梗阻最常见。肠梗阻的手术指征应根据临床表现、辅助检查综合评分确定，老年人肠梗阻手术风险较大。     

小肠排列术治疗复发性粘连性肠梗阻

目的 采用小肠排列术使无法控制的肠粘连变为可控制的肠粘连,以期防止粘连性梗阻的发生。方法 采用文献综述的方法介绍小肠排列术先后历经的3个阶段,即：（1）用缝合小肠似手风琴键样列固定在腹腔内;（2）用直针粗线将小肠系膜做U字形小肠排列缝合;（3）用米－阿氏管经小肠腔内排列。结果 较牢地固定了小肠益,使肠袢成弧形环状排列,避免了锐角;充分地进行了肠腔减压。随访45例（2－15年）,证实治愈率为91．9％。结论 手术操作不复杂,费时短,疗效可靠,有效地降低了粘连性肠梗阻的发生,受到外科医师的普遍接受。     

Spontaneous resolution of intestinal obstruction while receiving home parenteral nutrition

Six patients with intestinal obstruction secondary to benign adhesions so dense and vascular that the operating surgeon could not free them, were placed on a home total parenteral nutrition program. Four patients had enterocutaneous fistulas, and two had their bowels divided and stomas created to divert intestinal contents from distal enterotomies made during the attempt to free the intestine. The enterocutaneous fistulas closed in four patients within 2 weeks to 5 months and the obstructions spontaneously resolved in 2 to 3.5 months. At reoperation on the two patients whose intestinal tracts were purposely divided, the previously matted bowels with dense adhesions were easily freed. We believe complete gastrointestinal rest allows adhesions to mature into long avascular collagen fibers in the absence of a persistent inflammatory reaction that accompanies partial or total small bowel obstruction. We recommend that patients receive 3 months of home total parenteral nutrition before a second operation for persistent obstruction after recent enterolysis should be considered. Spontaneous resolution should occur, but if not, reoperation can be performed safely after the 3 month interval.     

Intestinal obstruction with strangulation of the small bowel

The records of 128 patients operated on for adhesive complete mechanical obstruction of the small intestine were retrospectively reviewed. The gut proved to be strangulated in 53 cases, irreversibly in 16 and reversibly in 37, while 75 patients had simple obstruction (12, 29 and 59%). Continuous abdominal pain was more common in strangulation than in simple obstruction and leukocytosis was most common in irreversible strangulation (both differences significant). But no preoperative clinical parameter was specific for strangulation obstruction. Preoperative hospital stay greater than 25 hours was significantly more common in irreversible strangulation obstruction than in the other groups. Strangulation was preoperatively recognized in only 25% of the cases. The overall mortality rate was 5.5%, but with no statistical intergroup difference, possibly because so few patients died. The study showed that strangulation usually is unrecognized preoperatively, and that early operation is essential for obstruction due to intestinal strangulation. Early surgery is therefore indicated in most cases clinically diagnosed as intestinal obstruction.     

腹部手术后早期炎性肠梗阻的治疗

目的 探讨术后早期炎性肠梗阻的特点及治疗原则。方法 回顾性分析近期经治的术后早期炎性肠梗阻 9例。结果 1例患者经手术治疗,分离粘连时引起多发性肠破裂、肠瘘,后经保守治疗治愈; 8例患者均经胃肠减压、抗炎、应用生长抑素等保守治疗治愈,平均治愈时间为 21. 5 d,无 1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,虽有机械性因素,但大多都是腹腔内炎症所致广泛粘连引起; (2)症状以腹胀为主,腹痛相对轻,部分患者有少量肛门排气排便,体征虽典型,但较少发生绞窄; (3)保守治疗大都有效,治疗上最好先予以生长抑素为主的保守治疗,应严密观察,如出现肠坏死、腹膜炎征象时则再及时中转手术。