活血理气中药预防术后肠粘连的实验研究

目的：观察中药对犬腹部手术后肠粘连的预防作用。方法：选健康家犬12只．随机分为二组，分别行大的盲肠切除、肠切除吻合、胃肠吻合、脾切除术，术后中药治疗组用中药浓缩煎剂加入犬食中喂养．70天后处死犬，剖腹观察术后腹腔内粘连情况。结果：中药治疗组大腹腔内粘连明显少于对照组（P＜0．01）．粘连程度轻于对照组。结论；中药对犬腹部手术肠粘连的预防有显著效果。     

东菱克栓酶预处理对缺血再灌注大鼠心肌收缩功能、SOD及丙二醛的影响

东菱克栓酶具有增强纤溶系统活性,减少血栓基质形成,降低血液粘滞性的作用,因而,临床上广泛用于动脉硬化引起的缺血性疾病。本研究的主要目的是探讨东菱克栓酶预处理对缺血再灌注大鼠心肌收缩功能及心肌超氧化物歧化酶(SOD)和丙二醛(MDA)的影响。材料与方法成年雄性SD大鼠30只,体重(300～350)g,随机分为空白对照组、缺血组、东菱克栓酶组,根据K-H液中东菱克栓酶的浓度又将东菱克栓酶组分为东菱克栓酶低浓度(5U·L-1)组(组1)、中浓度(10U·L-1)组(组2)及高浓度(20U·L-1)组(组3)等3个亚组。以戊巴比妥钠30mg·kg-1腹腔注射麻醉,同时腹…     

腹腔镜下手术治疗粘连性肠梗阻临床分析

目的探讨腹腔镜下手术治疗粘连性肠梗阻患者的疗效。方法将74例粘连性肠梗阻患者随机分为腹腔镜组与传统手术组各37例,均行肠粘连松解术,观察2组患者的治疗效果。结果腹腔镜手术组术中出血量、肠功能恢复时间和住院时间均显著优于开腹组(P<0.05)。而2组手术时间无差异(P>0.05)。腹腔镜组1例术后出现腹痛、腹胀反复发作,再次行腔镜下肠粘连松解术+肠减压+腹腔引流术治疗后痊愈出院;开腹组1例术后出现病情反复,再次开腹行肠粘连松解+肠排列术+小肠部分切除术治疗后痊愈。所有患者切口皆甲级愈合痊愈出院,无肠梗阻复发等远期严重并发症的发生。结论腹腔镜下粘连性肠梗阻手术安全可行,且具有切口小、出血少、恢复快等优点,值得在临床上推广。     

通腑活血药预防家兔肠粘连的实验研究

本实验采用家兔肠粘连模型,观察了通腑活血药对肠粘连的预防作用及肠粘连程度与血中纤维蛋白原含量的关系。结果:①通腑活血药能预防或减轻肠粘连(P＜0.05);②通腑活血药能抑制术后血中纤维蛋白原含量的增加(手术前后比P＞0.05);③术后肠粘连程度与血中纤维蛋白原含量呈正相关。表明通腑活血药预防肠粘连的机理之一是抑制术后血中纤维蛋白原的生成。     

薤白预防肠粘连的实验与临床研究

目的 探讨薤白对腹部手术后腹腔粘连与肠粘连的预防疗效.方法 随机选用家兔30只,制成肠粘连模型,分别以薤白组、新斯的明组、生理盐水组,进行实验研究,并在动物实验的基础上,应用薤白预防60例腹部术后患者观察治疗.结果动物实验薤白组预防治疗腹腔粘连与肠粘连优于新斯的明组和生理盐水组,差异有统计学意义(P<0.01).临床应用薤白组与对照组各60例作预防肠粘连与腹腔粘连观察治疗,薤白组优于对照组差异有统计学意义(P<0.05).结论 早期用薤白对术后肠粘连有较强的预防作用,患者肠功能恢复快,使用方便、安全、价廉,疗效可靠且无不良反应.     

腹腔镜腹腔内补片植入术治疗腹壁切口疝的效果及对机体炎症反应的影响

目的探讨腹腔镜腹腔内补片植入术(IPOM)治疗腹壁切口疝的效果及对机体炎症反应的影响。方法根据不同术式将48例腹壁切口疝患者分为2组,各24例。观察组实施腹腔镜IPOM术,对照组行开放腹腔内补片植入术。比较2组疗效及对机体C-反应蛋白(CRP)、白细胞介素-6 (IL-6)水平的影响。结果观察组下床活动时间、肠功能恢复时间、切口愈合时间均短于对照组,差异有统计学意义(P0.05)。术后24 h观察组CRP、IL-6水平均低于对照组,差异有统计学意义(P0.05)。结论对腹壁切口疝患者应用腹腔镜IPOM术,可缓解机体的炎症反应,促进患者术后恢复。     

通腑泻热灌肠合剂对术后肠粘连的预防的实验研究

腹腔手术后肠粘连，占各类肠梗阻的３７～６４％。为探讨通腑泻热灌肠合剂对术后肠粘连的作用机制，本实验采取大白鼠小肠浆膜镊子夹取损伤的方法制成肠粘连模型，将模型随机分成三组：通腑泻热合剂灌肠组，生理盐水灌肠组和空白对照组，术后连续灌肠２天，术后第６天检测结果。实验结果表明：通腑泻热合剂灌肠组与生理盐水灌肠组及对照组比较，能够明显减少肠粘连的处数（Ｐ＜０．０１），降低纤维蛋白原的含量（Ｐ＜０．０５），同时提高血谷胱甘肽歧化酶（ＧＳＨ－Ｐｘ）的含量（Ｐ＜０．０５），而血超氧化物歧化酶（ＳＯＤ）的含量无显著差异。结果提示：通腑泻热灌肠合剂能够降低纤维蛋白原，抑制纤维蛋白产生，降低组织炎症反应；同时，提高ＧＳＨ－Ｐｘ的含量，减少强氧化性的自由基对组织的损伤，加强机体防御自由基损伤的第二道防线，防止炎症的发生，从而达到预防粘连的目的。     

腹腔内粘连和脓肿形成的病理生理学及透明质酸对其的作用

复习腹腔内粘连和脓肿形成的病理生理学，以透明质酸为基础的制剂能减少术后肠粘连和腹腔内脓肿的形成，后两者的发生机制涉及凝血和纤溶平衡的紊乱及纤维蛋白降解的减少。透明质酸溶液则起机械性分离伤口接触面、改善腹膜愈合，调控炎症反应和促进纤溶。     

阑尾穿孔腹腔镜阑尾切除术41例临床分析

目的：总结腹腔镜阑尾切除术治疗阑尾穿孔并腹膜炎的效果。方法：分析41例患者阑尾穿孔并腹膜炎行腹腔镜手术的临床资料,并随机选择常规开腹手术40例为对照组,比较两组的手术时间、术后切口感染、腹腔残余感染及肠粘连等并发症的发生率。结果：腹腔镜组手术时间45～95min,平均61min,几乎无出血,术后穿刺口感染1例,肠间积液1例,无近期肠粘连等并发症。对照组40例手术时间50～110min,平均58min,腹腔残余感染8例,切口感染7例,近期肠粘连4例。结论：腹腔镜阑尾切除术是阑尾穿孔并腹膜炎的首选治疗方式,具有开腹手术无法比拟的优点,可明显降低切口感染、腹腔残余感染及肠粘连等并发症。取出阑尾时尽量不与穿刺口接触及术毕彻底冲洗腹腔是避免以上并发症的关键。     

过氧化氢液在腹膜炎手术中的应用(附50例报告)

近几年来,我们采用过氧化氢液冲洗腹腔治疗急性弥漫性腹膜炎患者共50例。对预防肠粘连及腹腔内残余感染取得了良好的效果,现介绍如下。临床资料治疗组男36例,女14例。年龄最大者73岁,最小4个月。随访最长者4年,最短半年。因化脓性阑尾炎穿孔手术者25例,外伤性肠破裂16例,胃十二指肠穿孔9例。此组50例患者均在术后12～18小时恢复肠鸣音,术后2～3天体温降至正常,切口愈合良好。其中发生粘连性肠梗阻者2例,无腹腔内残余感染征象。     

Effects of Proanthocyanidins on Intestinal Motility Disturbance Following Intestinal Ischemia/Reperfusion

Purpose: To investigate the potential protective effects of Proanthocyanidins(PAs) on intestinal motility disturbance following intestinal ischemia/reperfusion (I/R). Materials and Methods: Male rats were divided into four groups: Sham, I/R, I/R+PA100 and I/R+PA200. Sham group underwent laparotomy without ligation, the others were subjected to intestinal ischemia for 1 h and reperfusion 4 h. Rats in the I/R+PA100 group received PAs (100 mg/kg/d) for 5 days prior to I/R, while rats in the I/R+PA200 group received PAs (200 mg/kg/d). After reperfusion, using an electrophysiology instrument measured ileal slow wave. Ileal specimens were obtained to determine contractility, tissue levels of Bax, Bcl-2, and Caspase-3 and evaluate histopathological changes. In addition, blood sample was obtained to determine serum superoxide dismutase (SOD) activity and malondialdehyde (MDA) levels. Results: Intestinal I/R caused severe histopathological injury including mucosal erosions, inflammatory cell infiltration, necrosis, and hemorrhage. Both PAs treatment decreased mucosal pathological impairment in comparison with the I/R group (p < .05) in light microscopic evaluations. In both PAs-treated groups, Bax and Caspase-3 expression were decreased compared to I/R group, while the Bcl-2 expression increased (p < .05), which was similarly the case for serum SOD activity demonstrated significant enhance (p < .05) and decline in MDA levels in comparison with I/R group (both p < .05). Moreover, PAs treatment was more efficient in attenuating serum MDA levels of intestinal I/R (both p < .05). And the contractile amplitude and frequency of slow wave in I/R+PA100 and I/R+PA200 groups were higher than I/R group (both p < .05). Conclusions: PAs improve intestinal motility disturbance following intestinal I/R by alleviating oxidative stress and apoptosis.     

Intestinal Transplantation for Chronic Intestinal Pseudo-Obstruction in Adult Patients

Intestinal transplantation (ITx) has become a life-saving procedure for patients with irreversible intestinal failure who can no longer be maintained on parenteral nutrition (PN). This report presents the results of our experience on ITx in patients suffering from chronic intestinal pseudo-obstruction (CIPO). Between December 30, 2000 and May 30, 2003 six adult patients affected by CIPO underwent primary ITx at our Center. Pre-transplant evaluation, indication for ITx and surgical technique are reported. On December 30 2003, the mean follow-up was 25.0 months. No peri-operative deaths occurred in the study population and five out of six patients are alive, with 1-year patient and graft survival of 83.3% and 66.6%. Although our series is limited by the number of patients, our experience suggests that ITx transplantation should be considered in adult patients suffering from CIPO and PN life-threatening complication.     

大肠癌合并大肠息肉的外科治疗体会

为探讨大肠癌合并大肠息肉的手术处理方法及疗效,回顾分析56例大肠癌合并大肠息肉病例的诊治资料。结果显示,2004年3月至2009年7月收治的255例大肠癌患者中共发现并存大肠息肉者56例,其中45例行术前息肉摘除手术,7例行术中结肠息肉切除,4例在术后进行结肠息肉摘除。全组无手术并发症发生,息肉切除部位无残留、恶变或癌种植转移。结果表明,术前应用内镜切除是治疗大肠癌合并大肠息肉的主要手段;不宜内镜切除者,尽量采用扩大切除术;远离大肠癌常规切除范围、较分散的息肉和不宜扩大切除的患者,可在内镜定位下行局部切除,如为恶性息肉则行结肠次全或全切除。双镜联合可提高大肠息肉的诊治水平。     

Intestinal endometriosis. Current status

Endometriosis affects a wide spectrum of premenopausal women. Intestinal involvement, affecting mainly the large bowel and sometimes the small bowel, is much less frequent. Diagnosis is relatively straightforward in women with long standing pelvic endometriosis but is difficult in acute intestinal obstruction, since a diagnosis of endometriosis is not often considered in this entity. We performed an exhaustive review of the medical literature, including the option of medical treatment, which is rarely effective in intestinal endometriosis. In most patients with intestinal symptoms, the disease is so severe that surgical treatment is required. Recent studies indicate that the most effective approach is laparoscopic. We analyze the most important classical and recent series of patients and discuss treatment results.     

Serum and Intestinal Diamine Oxidase Activity During Intestinal Adaptation

Diamine oxidase (DAO) is a cytoplasmic enzyme found primarily in the villus epithelial cells of the small intestine. Serum DAO levels have been evaluated as a potential marker of intestinal disease in a variety of disorders, including gut atrophy, ischemia, and inflammation. In this study serum and tissue DAO levels were evaluated during intestinal adaptation. Twenty dogs were divided into 4 groups: sham laparotomy (n = 5), and 25% (n = 5), 50% (n = 5), and 75% (n = 5) distal enterectomy. Serum DAO activity (basal or postheparin) was measured prior to and 2 days, 4 weeks, 8 weeks, and 12 weeks after operation. Tissue DAO and changes in intestinal length, mucosal protein content, and villus height were measured at sacrifice 12 weeks later. Intestinal remnant length and protein content increased significantly with 50 and 75% resection. Tissue DAO activity was significantly decreased with any enterectomy. Serum postheparin DAO activity was significantly greater than basal at all time points but there was no significant change in either basal or postheparin DAO levels at any time following resection. It is concluded that serum DAO levels are not changed during the early adaptive period following intestinal resection and thus would not be useful as a marker of this process. Tissue DAO levels were diminished during adaptation, suggesting that tissue DAO activity is influenced not only by mucosal mass but by cellular metabolism and the proliferative status of the mucosa.     

Simultaneous Intestinal and Kidney Transplantation in Adults

Aim of the study: Intestinal transplantation (IT) is a life-saving procedure for carefully selected patients with intestinal failure. We evaluated patients who had undergone simultaneous intestinal and kidney transplantation (SIKT) to determine whether UK guidelines for inclusion of a renal allograft (dialysis dependent or estimated glomerular filtration rate ((eGFR)) < 45 ml/min/1.73 m²) are justified. Methods: A single centre analysis was undertaken of adults undergoing IT at the Cambridge Transplant Centre between December 2007 and January 2016. A prospectively maintained database was used to identify SIKT recipients and determine outcomes. Results: Over this period, 63 intestinal transplants were performed. Seven (11.1%) recipients received a SIKT. Five were pre-dialysis (median eGFR 29 ml/min/1.73 m², range 16–36 ml/min/1.73 m²). One recipient was on dialysis, and one needed bilateral nephrectomy at transplant. There were no primary kidney allograft failures and at three months, the median eGFR (55 ml/min/1.73 m² range 39–124) was similar to recipients of IT alone (median eGFR 56 ml/min/1.73 m² range 17–143 ml/min/1.73 m²). Two recipients required dialysis due to sepsis related kidney injury and died from multi-organ failure (20 and 63 months). Two died with a functioning renal transplant (10 and 15 months). The remaining three patients are alive at follow up (12–96 months) with an eGFR of 20–45 ml/min/1.73 m². Conclusion: Patients with significant renal impairment (eGFR <45 ml/min/1.73 m²), and receiving dialysis may benefit from SIKT. Patient survival and renal function are broadly comparable to those undergoing IT alone. Further studies are required to justify allocation of a kidney to this complex high risk group.     

Intestinal obstruction

Intestinal obstruction is a common surgical emergency. In the developed world approximately 20% of patients with acute abdominal pain admitted to surgical units have intestinal obstruction and 80% of these will have small bowel obstruction. In the western world, adhesional obstruction is by far the most common cause of small bowel obstruction, reflecting the increasing number of abdominal surgical procedures being performed. Malignancy is the leading cause of obstruction of the large intestine. The cardinal clinical features are vomiting, abdominal pain, distension and gross constipation which differ in predominance depending on the site of the obstruction. Management of bowel obstruction requires prompt identification, meticulous attention to fluid and electrolyte balance and timely surgical intervention.     

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。     

Prolongation of the Intestinal Viability Using Oxygenated Perfluorocarbon in an Experimental Model of Acute Intestinal Ischemia

OBJECTIVES: Liquid perfluorocarbons (PFCs) are well known for their capability to carry respiratory gases. The aim of this study was to evaluate the effectiveness of oxygenated F-Decalin on the intestinal viability, in an experimental model of acute intestinal ischemia. MATERIAL AND METHODS: Thirty-six rabbits were subjected to 8h intestinal ischemia by ligation of the superior mesenteric artery (subgroups 1), the mesenteric vein (subgroups 2) or both vessels (subgroups 3). The animals were divided into three groups: (a) Control (ischemia alone), (b) PFC-O2 (ischemia plus infusion of oxygenated F-Decalin) and (c) PFC (ischemia plus infusion of not-oxygenated F-Decalin). Intestinal biopsies from four different sites and blood samples for serum enzymes measurements were taken at 2, 4, 6 and 8 h. All tissue sections were examined blindly under light microscope. Sections from the specimens were taken at 4 and 8 h, and examined blindly under the electron microscope. Statistical analysis was performed by non-parametric Kruskal Wallis test. RESULTS: Using light microscope, the observed intestinal damages to the sections from Control and PFC groups were severe at 4 h and destructive after 8 h. On the contrary, minimal injuries were observed in the biopsies from PFC-O2 group at 4 and even after 8 h of ischemia. These findings were confirmed by the electron microscope study and correlated to the serum enzymes measurements. CONCLUSIONS: These results suggest that intestinal viability could be prolonged after acute ischemia using oxygenated perfluorocarbons and this could be a promising pretreatment modality for a variety of mesenteric ischemic forms.     

急性粘连性肠梗阻手术时机的探讨

目的探讨急性粘连性肠梗阻手术时机的选择。方法回顾性分析我院1998年1月～2003年12月经手术治疗的88例急性粘连性肠梗阻的临床资料。其中，因入院时即诊断肠绞窄而行急诊手术5例；先保守观察后手术治疗83例：腹部体征加重，辅助检查提示向绞窄性肠梗阻发展45例；造影剂24h内未能到达结肠12例；保守治疗4～5d无好转15例；肠梗阻反复发作11例。手术方式包括粘连松解术80例，坏死肠管切除吻合术4例，肠短路吻合术3例，小肠内固定术l例。结果术后发生肠外瘘1例，经保守治疗45d后痊愈；切口感染10例，经1T期缝合后治愈。结论急性粘连性肠梗阻在保守治疗过程中应及时发现早期肠绞窄的线索，果断决定手术治疗，手术时机宜早勿迟，手术指征宜宽勿严。