经鼻小肠减压管置入术在急性肠梗阻治疗中的应用

目的观察经鼻小肠减压管置入术在急性肠梗阻治疗中的应用效果。方法内镜或X线引导下经鼻小肠减压管置入行胃肠减压术治疗急性肠梗阻21例,X线检查观察导管造影情况,观察症状缓解情况。结果全部病例均一次性插管成功,无术中并发症发生。本组总有效率为90.48%(19/21),2例肿瘤性肠梗阻腹胀无明显缓解,中转手术治疗。所有病例均未出现穿孔和肠坏死。结论经鼻小肠减压管置入治疗急性肠梗阻疗效较好。     

内镜下经鼻肠梗阻导管置入在难治性肠梗阻手术治疗中的应用效果观察

目的 观察内镜下经鼻肠梗阻导管置入在难治性肠梗阻手术治疗中的应用效果,及术后胃肠道激素变化。方法难治性肠梗阻患者88例,采用随机数字法分为观察组与对照组,每组44例。对照组术前给予常规鼻胃管置入序贯外科手术治疗,观察组术前给予内镜下经鼻肠梗阻导管置入序贯外科手术治疗。观察两组置管情况,记录腹痛缓解时间、腹胀缓解时间、首次排气时间和首次排便时间,记录术后并发症发生情况;分别于术前及术后24、72 h采用ELISA法检测血清血管活性肽（VIP）和胃动素（MTL）。结果 两组均一次性置管成功,置管过程中患者耐受性较好,无消化道出血及穿孔发生。观察组术后腹痛缓解时间、腹胀缓解时间、首次排气时间、首次排便时间均较对照组缩短（P均<0.05）。两组术后24 h血清VIP水平高于术前,血清MTL水平低于术前（P均<0.05）。两组术后72 h血清VIP水平低于术后24 h,对照组术后72 h血清VIP水平仍高于术前（P均<0.05）;两组术后72 h血清MTL水平高于术后24 h,观察组术后72 h血清MTL水平高于术前（P均<0.05）。观察组术后24、72 h血清VIP水...     

经鼻型肠梗阻导管在腹部术后早期粘连性肠梗阻胃肠减压治疗中的应用

目的探讨经鼻型肠梗阻导管减压在腹部术后粘连性肠梗阻治疗中的作用。方法将136例腹部术后早期粘连性肠梗阻患者随机分为对照组和观察组各68例。对照组行传统鼻胃管置入胃肠减压治疗,48h后腹痛、腹胀无明显缓解者改行经鼻型肠梗阻导管胃肠减压治疗;观察组采用经鼻型肠梗阻导管行胃肠减压治疗。观察两组成功率及腹围减少量、胃肠减压量、平均住院时间。结果观察组成功率、腹围减少及胃肠减压量均明显高于对照组,P均〈0.05;但平均住院时间长于对照组（P〈0.05）。结论经鼻型肠梗阻导管置入胃肠减压效果确切,优于传统的鼻胃管。     

经鼻肠梗阻导管治疗小肠套叠所致的肠梗阻1例

小肠套叠所致的肠梗阻采用经鼻肠梗阻导管治疗的病例报道较少,本例通过经鼻肠梗阻导管治疗肠梗阻效果较好,并成功解除小肠套叠,现报道如下。     

超细胃镜引导下放置经鼻肠梗阻导管治疗肠梗阻26例

肠梗阻患者留置肠梗阻导管,比普通胃管更能有效地吸引肠内容物,降低肠管内压力,减轻水肿,恢复肠道血运及肠管动力,从而达到非手术解决肠梗阻的目的。临床上放置肠梗阻导管的方法很多,我院自2009年起采用超细胃镜引导下放置经鼻肠梗阻导管减压治疗肠梗阻,疗效满意,报道如下。     

经鼻胃镜放置肠梗阻导管治疗粘连性小肠梗阻的临床应用

我们将鼻胃镜经鼻插入28例粘连性小肠梗阻的患者十二指肠降段,经活检孔引入亲水性超滑导丝至空肠,退出鼻胃镜,将肠梗阻导管沿导丝送入空肠上段,充盈前气囊后,观察患者治疗前后症状有无缓解、腹围缩小情况及24 h引流量等指标。结果 显示28例患者均1次置管成功,成功率100%。置管时间为10～35 min,留管时间为3～18 d。术中均无并发症发生。患者临床症状均有不同程度改善;24 h引流量480～1 550 mL,平均885 mL;置管24 h后患者腹围（79.1%±20.3%）显著小于置管前（100%,P〈0.05）。可见经鼻胃镜放置肠梗阻导管简便、易行,治疗粘连性小肠梗阻疗效确切,应作为治疗粘连性小肠梗阻的首选方法。     

经鼻肠梗阻导管在术后早期炎性肠梗阻中的应用

目的探讨经鼻肠梗阻导管在术后早期炎性肠梗阻治疗中的作用。方法将36例术后早期炎性肠梗阻患者随机行经鼻肠梗阻导管（n=18）、普通鼻胃管（n=18）减压治疗,分别观察腹围缩小、胃肠减压量、呕吐停止时间、排气、排便恢复时间、气液平面消失时间,对结果进行分析比较。结果经鼻肠梗阻导管的腹围缩小（16.4±5.2）cm较普通鼻胃管（5.9±3.2）cm更明显,胃肠减压量（1035.6±274.5）ml/d较普通鼻胃管（626.8±304.6）ml/d显著增多,呕吐停止时间（2.2±1.8）d、排气恢复时间（1.8±0.9）d、排便恢复时间（5.2±3.4）d和气液平面消失时间（9.3±7.5）d均较普通鼻胃管显著缩短（P〈0.05）。结论经鼻肠梗阻导管在术后早期炎性肠梗阻中较普通鼻胃管更有意义。     

经鼻型肠梗阻导管在肠梗阻治疗中的临床价值

目的观察经鼻型肠梗阻导管治疗肠梗阻的临床疗效。方法 28例不全性肠梗阻患者经常规治疗无效后安置肠梗阻导管,观察肠梗阻缓解的各项临床指标,即腹胀、腹痛、腹围变化、腹部立卧位平片气液平消失的时间和非手术率的变化。结果 28例患者,肠梗阻完全缓解者21例,时间24~240 h,其中外科手术后所致黏连性肠梗阻16例,克罗恩病1例,肠结核1例,粪石性肠梗阻1例,小肠柿石2例。非手术率75.0%。肠梗阻未能缓解转外科行手术治疗7例,包括结肠肿瘤3例,小肠癌1例,小肠内疝1例,肠道淋巴瘤1例,小肠巨大粪石1例。结论经鼻型肠梗阻导管治疗不全性肠梗阻可明显改善患者临床症状,提高非手术率,为外科手术病变部位定位。     

小肠减压管联合结肠金属支架置入治疗恶性结肠梗阻的临床研究

目的 探索小肠减压管联合结肠金属支架置入治疗恶性结肠梗阻的临床价值。方法 回顾性队列研究收集2010年6月至2018年9月在浙江大学医学院附属杭州市第一人民医院消化科因恶性结肠梗阻接受消化内镜治疗的患者，根据治疗方案，分为小肠减压管联合结肠金属支架置入组（联合组）和单纯结肠金属支架置入组（单纯组），比较两组在支架操作成功率、并发症发生率、后续外科手术吻合方式及并发症发生率、住院天数及治疗费用等方面的差异。结果 共纳入83例患者，其中联合组18例，单纯组65例，两组患者一般情况比较差异无统计学意义（P>0.05）。联合组与单纯组支架置入成功率比较差异无统计学意义[100%（18/18）比 98.5%（64/65），?2=0.280，P=0.597），支架置入术后并发症发生率比较差异也无统计学意义[5.6%（1/18）比 21.9%（14/64），?2=2.432，P=0.119）。联合在有8例、单纯组有24例在我院行外科手术治疗，联合组支架置入到外科手术时间（6.75±1.28）d，短于单纯组的（9.58±5.76）d（t=3.649，P=0.000），联合组外科术后感染并发症发生率12.5%（1/8），低于单纯组的54.2%（13/24）（P=0.045）。两组手术吻合方式、住院天数、住院费用比较差异无统计学意义（P>0.05）。结论 内镜下金属支架置入或联合小肠减压管治疗恶性肠梗阻安全有效，且金属支架置入前使用小肠减压管可缩短接受外科手术时间，降低外科手术后感染发生率。     

经鼻肠梗阻导管在老年术后早期炎性肠梗阻治疗中的应用

术后早期炎性肠梗阻(EPISBO)是近年来逐渐被人们所认识的一种特殊类型的肠梗阻,是在腹部术后早期(术后2 w),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而形成的一种机械性与动力性同时存在的黏连性肠梗阻~([1]).在治疗上由于该病特殊的病理机制,短期内再次手术的风险较大,容易导致症状的加重,甚至形成肠瘘、短肠等严重并发症~([2]),故以保守治疗为主.在改善患者一般状态的基础上,有效减压是治疗的关键~([3]).本文探讨经鼻肠梗阻导管在EPIBSO非手术治疗中的作用.     

Chemotherapy induced small bowel obstruction in small cell lung cancer

Lung cancer is the leading cause of cancer related death in men and the second cause in women worldwide. We describe a case of a 51- year old lady with small cell lung cancer who developed small bowel obstruction following chemotherapy with cisplatin and etoposide. Abdominal CT scan showed changes confined to the jejunum and proximal ileum with diffuse mural thickening and hyper-attenuation of the mucosa with sparing of the terminal ileum, caecum and colon. Her condition improved with conservative management and intravenous antibiotics.     

Percutaneous needle decompression in treatment of malignant small bowel obstruction

AIM:To investigate the efficacy and safety of percutaneous needle decompression in the treatment ofmalignant small bowel obstruction(MSBO).METHODS:A prospective analysis of the clinical data of 52 MSBO patients undergoing percutaneous needle decompression was performed.RESULTS:Percutaneous needle decompression was successful in all 52 patients.Statistically significant differences were observed in symptoms such as vomiting,abdominal distension and abdominal pain before and after treatment(81.6%vs 26.5%,100%vs 8.2%,and 85.7%vs 46.9%,respectively;all P<0.05).The overall significantly improved rate was 19.2%(11/52)and the response rate was 94.2%(49/52)using decompression combined with nasal tube placement,local arterial infusion of chemotherapy and nutritional support.During the one-month follow-up period,puncture-related complications were acceptable.CONCLUSION:Percutaneous needle intestinal decompression is a safe and effective palliative treatment for MSBO.     

Decompression of the small bowel by endoscopic long-tube placement

AIM: To investigate and compare the decompression effect on small bowel obstruction of a long tube inserted using either endoscopic or fluoroscopic placement.METHODS: Seventy-eight patients with small bowel obstruction requiring decompression were enrolled in the study and divided into two groups. Intubation of a long tube was guided by fluoroscopy in one group and by endoscopy in the other. The duration of the procedure and the success rate for each group were evaluated.RESULTS: A statistically significant difference in the mean duration of the procedure was found between the fluoroscopic group (32.6 ± 14.6 min) and the endoscopic group (16.5 ± 7.8 min) among the cases classified as successful (P < 0.05). The success rate was significantly different between the groups: 88.6% in the fluoroscopic group and 100% in the endoscopic group (P < 0.05).CONCLUSION: For patients with adhesive small bowel obstruction, long-tube decompression is recommended and long-tube insertion by endoscopy was superior to fluoroscopic placement.     

Sequential stenotic strictures of the small bowel leading to obstruction

Small bowel obstructions （SBOs） are primarily caused by adhesions, hernias, neoplasms, or inflammatory strictures. Intraluminal strictures are an uncommon cause of SBO. This report describes our findings in a unique case of sequential, stenotic intraluminal strictures of the small intestine, discusses the differential diagnosis of intraluminal intestinal strictures, and reviews the literature regarding intraluminal pathology.     

Left paraduodenal hernia presenting as recurrent small bowel obstruction

Internal herniation of the small bowel is a relatively rare cause of intestinal obstruction. Left paraduodenal hernia resulting from abnormal rotation of the midgut during embryonic development is the most common form of congenital internal hernia. We report our experience in the diagnosis and management of a young male with left paraduodenal hernia presenting as recurrent intestinal obstruction. Correct preoperative diagnosis of left paraduodenal hernia had been difficult due to non-specific clinical presentations, but the advent of modern imaging technology makes early and correct diagnosis possible. Due to the risk of obstruction and strangulation, surgical treatment is indicated; however, timely intervention increases the likelihood of a favorable outcome.     

Persistent omphalomesenteric duct causing small bowel obstruction in an adult

An extremely rare case of persistent omphalomesenteric duct causing small bowel obstruction is presented. A 20-year-old female patient without medical history presented with colicky abdominal pain, vomiting, absence of passage of gas and feces, and abdominal distension of 24 h duration. Physical examination and blood tests were normal. Abdominal X-ray showed small bowel obstruction. Computed tomography of the abdomen demonstrated dilated small bowel and a band originating from the umbilicus and continuing between the small bowel loops; an omphalomesenteric duct remnant was suspected. In exploratory laparotomy, persistent omphalomesenteric duct causing small bowel obstruction was identified and resected. The patient had an uneventful recovery and was discharged on the 5^th postoperative day. Although persistent omphalomesenteric duct is an extremely infrequent cause of small bowel obstruction in adult patients, it should be taken into consideration in patients without any previous surgical history.     

A prospective randomized trial of transnasal ileus tube vs nasogastric tube for adhesive small bowel obstruction

AIM:To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction.METHODS:A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized controlled study.The endoscopically advanced new ileus tube was used for gastrointestinal decompression in 96 patients and ordinary nasogastric tube(NGT) was used in 90 patients.The therapeutic efficacy was compared between the two groups.RESULTS:Compared with the NGT group,the ileus tube group experienced significantly shorter time for relief of clinical symptoms and improvement in the findings of abdominal radiograph(4.1 ± 2.3 d vs 8.5 ± 5.0 d) and laboratory tests(P 0.01).The overall effectiveness rate was up to 89.6% in the ileus tube group and 46.7% in the NGT group(P 0.01).And 10.4% of the patients in the ileus tube group and 53.3% of the NGT group underwent surgery.For recurrent adhesive bowel obstruction,ileus tube was also significantly more effective than NGT(95.8% vs 31.6%).In the ileus tube group,the drainage output on the first day and the length of hospital stay were significantly different depending on the treatment success or failure(P 0.05).The abdominal radiographic improvement was correlated with whether or not the patient underwent surgery.CONCLUSION:Ileus tube can be used for adhesive small bowel obstruction.Endoscopic placement of the ileus tube is convenient and worthy to be promoted despite the potential risks.     

Diagnostic effect of capsule endoscopy in 31 cases of subacute small bowel obstruction

AIM： TO evaluate the effectiveness and safety of capsule endoscopy （CE） in patients with recurrent subacute small bowel obstruction.METHODS： The study was a retrospective analysis of 31 patients referred to hospital from January 2003 to August 2008 for the investigation of subacute small bowel obstruction, who underwent CE. The patients were aged 9-81 years, and all of them had undergone gastroscopy and colonoscopy previously. Some of them received abdominal computed tomography or small bowel follow-through.RESULTS： CE made a definitive diagnosis in 12 （38.7%） of 31 cases： four Crohn＇s disease （CD）, two carcinomas, one intestinal tuberculosis, one ischemic enteritis, one abdominal cocoon, one duplication of the intestine,one diverticulum and one ileal polypoid tumor. Capsule retention occurred in three （9.7%） of 31 patients, and was caused by CD （2） or tumor （1）. Two with retained capsules were retrieved at surgery, and the other one of the capsules was spontaneously passed the stricture by medical treatment in 6 too. No case had an acute small bowel obstruction caused by performance of CE.CONCLUSION： CE provided safe and effective visualization to identify the etiology of a subacute small bowel obstruction, especially in patients with suspected intestinal tumors or CD, which are not identified by routine examinations.     

Retroperitoneal fibrosis： A rare cause of both ureteral and small bowel obstruction

INTRODUCTION Retroperitoneal fibrosis (RPF) is a rare condition of unclear etiology. It is believed to be immune-related About two-thirds of the cases are thought to be idiopathic We present a case of idiopathic RPF in a 54 years old female who developed bilateral hydronephrosis and thensmall bowel obstruction due to extrinsic compression from retroperitoneal fibrosis. To our knowledge no case of idiopathic RPF presenting with features of both bilateral ureteral and small bowel obstru…