结肠透析联合中药保留灌肠治疗溃疡性结肠炎效果观察

目的探讨结肠透析联合中药灌肠辅助治疗溃疡性结肠炎的效果。方法对66例渍疡性结肠炎患者按住院时间的顺序分为对照组（36例）和观察组（30例），对照组采取传统中药保留灌肠，观察组用结肠透析仪行结肠灌洗，再注入中药保留灌肠治疗。结果观察组治疗总有效率显著高于对照组（P〈0.01）；肠道内药物保留效果显著优于对照组（P〈0.05）。结论结肠透析联合中药保留灌肠可提高渍疡性结肠炎疗效。     

气流弥散结肠导入疗法治疗溃疡性结肠炎效果观察

目的 提高溃疡性结肠炎患者中药灌肠治疗的效果.方法 将726倒溃疡性结肠炎患者随机分为观察组(426例)和对照组(300例).观察组采用中药气流弥散结肠导入疗法治疗,对照组采用中药传统灌肠疗法治疗.结果 两组治疗效果及复发率比较,差异有统计学意义(P＜0.05,P＜0.01).结论 气流弥散结肠导入疗法治疗溃疡性结肠炎较传统保留灌肠效果好.     

气流弥散结肠导入疗法治疗溃疡性结肠炎效果观察

目的提高溃疡性结肠炎患者中药灌肠治疗的效果。方法将726例溃疡性结肠炎患者随机分为观察组（426例）和对照组（300例）。观察组采用中药气流弥散结肠导入疗法治疗,对照组采用中药传统灌肠疗法治疗。结果两组治疗效果及复发率比较,差异有统计学意义（P〈0．05,P〈0．01）。结论气流弥散结肠导入疗法治疗溃疡性结肠炎较传统保留灌肠效果好。     

结肠透析联合药物保留灌肠在溃疡性结肠炎中应用的临床观察

目的 探讨结肠透析联合药物保留灌肠治疗溃疡性结肠炎的效果.方法 对80例溃疡性结肠炎患者按住院时间的顺序分为对照组(38例)和观察组(42例),对照组采取传统清洁灌肠加药物保留灌肠,观察组用结肠透析仪行结肠灌洗,再注入药物保留灌肠治疗.结果 观察组治疗总有效率显著高于对照组(P<0.01);肠道内药物保留时间显著优于对照组(P<0.05).结论 结肠透析联合药物保留灌肠可提高溃疡性结肠炎治疗的效果.     

自制中药灌肠液治疗溃疡性结肠炎

溃疡性结肠炎亦称慢性、非特异性、溃疡性结肠炎．是一种原因不明的主要发生在结肠粘膜层的炎症性病变．多因情绪激动，饮食不节或劳倦等反复发作。患者以腹痛，里急后重，持续腹泻、粘液脓血便．体重减轻为主要临床特征．属于中医“泄泻”范畴。2003年1～12月．我科对10例溃疡性结肠炎患者采用自制中药灌肠液保留灌肠．取得了满意效果，报告如下。     

结肠灌注机洗肠加溃灵汤保留灌肠治疗全结肠溃疡性结肠炎13例临床观察

为探讨结肠灌注机洗肠加溃灵汤保留灌肠治疗全结肠溃疡性结肠炎的临床疗效,回顾分析采用结肠灌注机洗肠配合溃灵汤保留灌肠治疗（治疗组）和口服柳氮磺吡啶治疗（对照组）的患者资料,进行疗效对比分析。结果显示,治疗组治愈6例,显效3例,好转3例,无效1例,总有效率为92．3％;对照组治愈1例,显效1例,好转3例,无效2例,总有效率为71．4％。治疗组总有效率明显高于对照组,P〈0．01。结果表明,结肠灌注机洗肠加溃灵汤保留灌肠治疗全结肠溃疡性结肠炎疗效好,不良反应小。     

中西医结合治疗溃疡性结肠炎

报告30例溃疡性结肠炎采用中西医结合治疗的疗效观察,效果满意,方法安全简单,无毒副作用,易于推广.     

机器人全结、直肠切除及回肠造口术治疗溃疡性结肠炎6例报告

目的:探讨机器人全结、直肠切除及回肠造口术治疗溃疡性结肠炎的应用价值及手术技术。方法:回顾分析2012年7月至2016年12月接受机器人全结、直肠切除及回肠造口术的6例溃疡性结肠炎患者的临床资料,统计分析手术时间、机器人与患者对接时间、医生控制台操作时间及手术并发症等指标。结果:6例手术均应用达芬奇Si手术机器人完成,无中转开腹或中转腹腔镜手术。前4例手术采用6孔或7孔法操作,后2例手术简化为5孔法操作。术中需要2次变换体位与机器人床旁操作系统位置,共计3次人机对接。手术时间259~650 min,平均(409±132)min;其中人机对接时间30~128 min,平均(53±37)min,医生控制台操作时间142~370 min,平均(214±87)min。出血量平均(175±144)ml。后5例手术时间、出血量等均明显少于第1例手术。术后患者恢复顺利3例发生会阴部切口感染,1例患者术后3个月时回肠造口狭窄,经再次手术治愈。结论:应用达芬奇手术机器人,采用"五孔三步法"行完全机器人全结、直肠切除、回肠造口术安全、可靠,易于操作,是溃疡性结肠炎可供选择的手术方法。     

中西药交替灌肠治疗溃疡性结肠炎30例

目的 中西医结合灌肠与单纯常规西药口服、静滴治疗溃疡性结肠炎的疗效比较.方法 治疗组30例,采用中药自拟方与西药交替灌肠;对照组30例采用单纯西药口服、肌注、静滴.结果 总有效率治疗组98%,对照组68%,两组差异有统计学意义(P<0.05);复发率治疗灌肠组10%,对照组40%(P＜0.05);不良反应:灌肠组未出现明显不良反应,对照组有不同程度头痛、恶心、满月脸等.结论 中西药交替保留灌肠治疗溃疡性结肠炎,临床观察疗效明显,基本无不良反应.     

中药灌肠治疗溃疡性结肠炎的疗效观察

为观察中药灌肠治疗溃疡性结肠炎的临床疗效,我院采用中药保留灌肠为主治疗溃疡性结肠炎127例。结果显示,痊愈37例,显效47例,有效39例,无效4例,总有效率达96．85％（123／127）。结果表明,中药灌肠治疗溃疡性结肠炎操作简单,且安全、有效。     

初发型溃疡性结肠炎致中毒性巨结肠五例分析

目的 探讨发型溃疡性结肠炎致中毒性巨结肠的临床表现及诊治方法.方法 回顾性分析2003年6月至2008年10月收治的5例初发型UC致中毒性巨结肠患者的临床资料.结果 5例患者首发症状均为腹痛、腹胀,因口服泻剂而诱发中毒性巨结肠,2例发生肠穿孔.4例女性患者出现神志异常,4例行磁共振检查,3例示腔隙性脑梗塞.该5例患者均接受手术探查,且在术前均未确立溃疡性结肠炎的诊断.5例均行部分结肠切除及肠造口术,平均手术2.4次.术后死亡1例.吻合口瘘1例,吻合口狭窄1例.结论 腹痛、腹胀及服用导泻剂后临床症状加重是初发型溃疡性结肠炎致中毒性巨结肠常见的临床表现.     

溃疡性结肠炎的外科治疗16例分析

目的探讨溃疡性结肠炎的外科治疗方式。方法对16例行外科手术治疗的溃疡性结肠炎的临床资料进行回顾性分析。结果本组16例行外科手术治疗，占全部收治患者的20．5％（16／78）。手术原因包括保守治疗无效10例，肠梗阻3例，合并息肉可疑癌变3例。行全结直肠切除、回肠造口术8例，全结直肠全切除、回肠肛管吻合术4例，结肠全切除、回直肠吻合术2例，结肠部分切除2例。结论溃疡性结肠炎主要手术指征为内科治疗无效或合并肠梗阻及并发息肉可疑癌变者。全结肠切除、回肠造口术治疗较彻底，全结直肠切除、回肠贮袋肛管吻合术可改善排便控制功能，但吻合口溃疡发生率高。     

Pain management in fulminating ulcerative colitis

BACKGROUND: Toxic megacolon is a life-threatening complication of ulcerative colitis (UC) characterized by systemic toxicity, loss of blood per rectum and severe pain. Pain management is challenging in these patients because nonsteroidal anti-inflammatory drugs may exacerbate bleeding and opioids are contraindicated because they adversely affect bowel peristalsis causing an increased risk of colonic perforation. METHODS: We describe three episodes of fulminating UC in two children in whom ketamine analgesia was used. Our protocol for a low-dose continuous ketamine infusion with either nurse-controlled analgesia (NCA) or patient-controlled analgesia (PCA) bolus administration is presented and a review of the literature regarding the use of ketamine analgesia in children is discussed. RESULTS: Low-dose ketamine N/PCA with a continuous background infusion provided satisfactory analgesia and none of our children reported adverse effects. CONCLUSIONS: We have demonstrated the safe and effective use of ketamine analgesia in children with toxic megacolon, a condition in which the child is in severe pain and morphine is contraindicated.     

顽固性溃疡性结肠炎的外科治疗

目的 评价顽固性溃疡性结肠炎(ulcerative colitis,UC)患者采用全结直肠切除、回肠贮袋肛管吻合手术(ileal pouch-anal anastomosis,IPAA)治疗的临床效果和应用价值.方法 对1990—2010年60例符合手术指征的顽固性UC患者行IPAA治疗,观察分析其术后近期、远期并发症,评价肛门自制功能及术后粪便性状分类,采用克利夫兰生活质量量表(Clevend Global Quality of Life index,CGQL)进行手术前后生活质量评估对比,采用单因素方差方法进行统计分析.结果 60例术后随访均2年以上.术后近期并发症发生率为15％ (9/60),包括腹腔、盆腔感染、贮袋吻合口漏、贮袋出血、贮袋阴道瘘和肠梗阻等,远期并发症发生率12％(7/60),包括贮袋炎、肠梗阻和男性性功能障碍等.术后12个月的24 h和夜间大便次数分别为(3.5±1.3)次和(1.4±0.6)次.气便分辨能力良好者93％(56/60),需要日常戴垫者3％(2/60).Kirwan分级评价肛门自制功能结果为Ⅰ级者54例(90％),Ⅱ级者4例(7％),Ⅲ级者2例(3％).Bristol粪便分类评价结果为Ⅳ类者31例(52％),V类者25例(42％),Ⅵ类者4例(6％).CGQL量表法评价IPAA手术前后生活质量,术后较术前明显改善(F=12.368,P＜0.05).结论 顽固性UC具备外科治疗指征,IPAA是首选术式,临床应用安全,疗效满意,生活质量明显改善.     

阑尾残端置管给药治疗难治性溃疡性结肠炎的临床探讨(附16例报告)

目的探讨难治性重型溃疡性结肠炎的有效治疗方法。方法回顾性分析我院1997年1月～2006年12月采用经阑尾残端置管给药治疗难治性重型溃疡性结肠炎16例的临床资料。结果完全缓解10例,有效6例。结论经阑尾残端置管给药行规范化的内科治疗具有副作用小、操作简单、使用方便、疗效好的优点,对难治性及重症溃疡性结肠炎不失为一种有效的治疗方法。     

腹腔镜全结肠切除术在家族性腺瘤性结肠息肉病及溃疡性结肠炎中的临床应用

目的:探讨腹腔镜全结肠切除术在家族性腺瘤性结肠息肉病(familial adenomatous polyposis,FAP)及溃疡性结肠炎(ulcerative colitis,UC)治疗中的应用价值。方法:回顾分析2009～2012年为12例患者行腹腔镜全结肠切除术(FAP患者7例,UC患者5例)及18例传统开腹全结(直)肠切除术(FAP患者7例,UC患者11例)的临床资料。结果:腹腔镜组在切口长度、术中出血量、术后止痛药使用量、术后排气时间、拔除导尿管时间、术后住院时间等方面优于开腹组,住院总花费明显高于传统开腹手术。结论:腹腔镜全结肠切除术用于FAP及UC安全、可行,与传统开腹手术相比,具有患者创伤小、康复快等优点,手术效果不亚于传统开腹手术,具有较高的临床应用价值。     

Surgical management of ulcerative colitis and Crohn's disease

The term inflammatory bowel disease is used to describe two conditions ‒ ulcerative colitis and Crohn's disease. Due to the complex nature of the disease, the treatment can be varied from each case to case and is usually approached by multidisciplinary team management. In this article, we focus on the surgical treatment options for inflammatory disease especially relating to basic principles.     

Medical management of Crohn's disease and ulcerative colitis

Ulcerative colitis and Crohn's disease are common conditions, which are seen frequently in both gastroenterology and surgical clinics, and are a significant burden on inpatient work. They are diseases with systemic manifestations and management of these patients can be difficult in complex cases. There is a wide variety of management options available, including management with medications, dietary modifications and surgery. We outline the current options available to clinicians.     

Blowhole colostomy for the urgent management of distal large bowel obstruction

Background

Complete obstruction of the distal colon or rectum often presents as a surgical emergency. This study evaluated the efficacy of blowhole colostomy versus transverse loop colostomy for the emergent management of distal large intestinal obstruction.

Methods

Retrospective chart review of all colostomy procedures (CPT 44320) performed for complete distal large bowel obstruction during the past 6 y in a university hospital practice was undertaken. Blowhole was compared with loop colostomy with a primary endpoint of successful colonic decompression.

Results

One hundred forty-one patients underwent colostomy creation during the study period. Of these, 61 were completed for acute obstruction of the distal colon or rectum (19 blowhole versus 42 loop colostomy). No differences between study groups were seen in age, gender, body mass index, malnutrition, American Society of Anesthesiology class, time to liquid or regular diet, 30-d or inhospital mortality, or rates of complications. Patients undergoing blowhole colostomy had significantly higher cecal diameters at diagnosis (9.14 versus 7.31 cm, P = 0.0035). Operative time was shorter in blowhole procedures (43 versus 51 min, P = 0.017). Postoperative length of stay was significantly shorter for blowhole colostomy (6 versus 8 d, P = 0.014). The primary endpoint of successful colonic decompression was met in all colostomy patients.

Conclusions

Diverting blowhole colostomy is a safe, quick, and effective procedure for the urgent management of distal colonic obstruction associated with obstipation and massive distention.