经鼻肠梗阻导管小肠内排列术与传统手术治疗急性小肠梗阻临床对比研究

目的 比较经鼻肠梗阻导管小肠内排列术与传统手术治疗急性肠梗阻的临床疗效。 方法 回顾性分析大连医科大学附属第一医院普外三科2005年4月至2010年12月手术治疗并获得随访的129例机械性小肠梗阻病人的临床资料。其中行经鼻肠梗阻导管小肠内排列术组41例,传统手术组88例。 结果 两组术后排气、排便时间、术后并发症发生率、术后病死率差异均无统计学意义（P>0.05）;经鼻肠梗阻导管小肠内排列术组术后5年复发率为5.0%（2/40）,明显低于传统手术组［18.8%（16/85）,P<0.05］,且复发时间（42.5±7.8）个月明显晚于传统手术组［（20.3±11.8）］个月（P<0.05）］。 结论 经鼻肠梗阻导管小肠内排列术防治肠梗阻复发效果良好。     

术后粘连性肠梗阻应用经鼻肠梗阻导管置入术的治疗体会

目的探讨经鼻肠梗阻导管置入术治疗术后粘连性肠梗阻的效果。方法对43例术后粘连性肠梗阻患者采取经鼻肠梗阻导管置入术,观察治疗效果。结果本组患者腹部症状缓解时间(2.08±0.46)d,恢复排气排便时间(3.65±1.96)d,气液平面消失时间(5.29±1.96)d。依据疗效评判标准本组总有效率95.35%(41/43)。结论经鼻肠梗阻导管置入术治疗术后粘连性肠梗阻,解除梗阻成功率高,症状改善明显。     

经鼻肠梗阻导管置入术治疗老年术后粘连性肠梗阻的体会

目的总结经鼻肠梗阻导管置入术治疗老年术后粘连性肠梗阻的体会。方法将68例老年术后粘连性肠梗阻患者随机分为2组,各34例。对照组置入鼻胃管胃肠减压术,观察组实施经鼻肠梗阻导管置入术。比较2组患者每日胃肠减压量,腹胀症状缓解时间,肛门恢复排气、排便时间,气液平面消失时间及治疗总有效率。结果观察组每日胃肠减压量显著多于对照组,腹胀症状缓解时间及肛门恢复排气、排便时间和气液平面消失时间均显著短于对照组,治疗总有效率高于对照组,差异均有统计学意义(P0.05)。结论经鼻肠梗阻导管置入术治疗老年术后粘连性肠梗阻,临床症状缓解时间短,治疗总有效率高。     

应用肠梗阻导管术中小肠内排列治疗粘连性肠梗阻

目的探讨肠梗阻导管经由自然孔道行小肠排列治疗粘连性小肠梗阻和预防梗阻复发的适应证、方法和疗效。方法 2007年7月至2011年9月,共纳入需手术治疗的粘连性肠梗阻患者21例。术前诊断:肠粘连松解术后15例,宫外孕术后1例,直肠Dixon术后1例,先天性小肠旋转不良1例,腹茧症1例,阑尾穿孔切除术后2例。手术方式:肠粘连松解术9例,肠粘连松解+小肠部分切除术10例,肠粘连松解术及横结肠造口术1例,末端回肠造口术1例。术中同时置入肠梗阻导管经鼻行小肠内排列,术中引导至末端回肠。患者常规治疗包括:禁食、纠正水电解质和酸碱失衡、营养治疗,支持治疗等。结果术中成功置管20例粘连性小肠梗阻患者,1例置管未成功。平均置管时间(15±9)min。平均胃肠减压量为:(502±114)ml/d;全组患者术后平均(4.4±3.2)d排气,术后(6.2±2.2)d开始带管进流食。术后平均(14.7±7.6)d拔管,术后均顺利拔管。置管期间并发症发生率15.0%(3/20):2例切口感染;1例鼻咽炎。术后随访20例5～40个月,2例(10.0%)在术后6个月内出现间断腹胀,经对症治疗后缓解。治愈率为90.0%,无因肠梗阻而再手术病例。结论在肠粘连松解和肠切除的基础上,应用肠梗阻导管进行小肠内排列术,操作简单,微创,疗效可靠。可明显改善粘连性肠梗阻患者症状,降低肠梗阻的复发率。在严格掌握适应证的前提下,可作为小肠内排列的选择术式之一。     

导管肠内排列预防粘连性肠梗阻63例分析

目的探讨肠梗阻导管术中小肠内排列应用于多发小肠破裂手术,是否有效预防粘连性肠梗阻。方法回顾性分析本院2012年1月至2017年1月收治的135例腹部闭合性损伤小肠多发破裂手术患者,按是否术中插入肠梗阻导管分为肠梗阻导管组63例和鼻胃管组72例,统计术后24小时的引流管液体积,48小时腹围变化,白细胞恢复时间,CRP恢复时间,肛门排气时间,随访8月至5年内间断腹胀发生率,粘连性肠梗阻发生率。结果肠梗阻导管组24小时胃肠减压量较鼻胃管组明显增多(P0.05),48小时腹围增幅明显小于鼻胃管组(P0.05),白细胞恢复时间、CRP恢复时间和肛门排气时间均明显小于鼻胃管组(P0.05)。术后随访,间断腹胀有3例(4.7%),粘连性肠梗阻2例(3.1%),鼻胃管组间断腹胀15例(20%),粘连性肠梗阻10例(13.8%),两组统计有显著差别(P0.05)。结论肠梗阻导管术后小肠内排列可减轻腹部闭合伤多发肠破裂术后粘连性肠梗阻,且操作简单、安全等优点,可作为具有粘连性肠梗阻高危因素手术的术中选择。     

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。     

胃镜下经鼻型肠梗阻导管置入术治疗急性粘连性肠梗阻疗效观察

目的探讨胃镜下经鼻型肠梗阻导管置入术治疗急性粘连性肠梗阻的效果与可行性。方法收集西平县人民医院收治的80例急性粘连性肠梗阻患者,均实施非手术治疗。将2013-12—2015-12间住院的40例患者作为对照组,实施鼻胃管胃肠减压。将2016-01—2018-01间住院的40例患者作为观察组,实施经胃镜置入鼻型肠梗阻导管胃肠减压。结果观察组术后胃肠减压量、腹痛缓解时间、恢复排气排便时间、气液平面消失时间、住院时间及治疗总有效率均优于对照组,差异有统计学意义(P0.05)。结论对急性粘连性肠梗阻患者在胃镜下经鼻型肠梗阻导管置入术实施胃肠减压,梗阻缓解快,总有效率优于鼻胃管胃肠减压。     

DSA引导下经鼻肠梗阻导管置入治疗难治性粘连性肠梗阻

目的探讨DSA引导下经鼻肠梗阻导管置入治疗难治性粘连性肠梗阻的效果。方法对50例难治性粘连性肠梗阻患者给予DSA引导下经鼻肠梗阻导管治疗,统计置管时间,腹痛、腹胀缓解时间,负压引流量,肛门排气及排便时间;术后第3、6天统计导管进入长度,并复查腹部X线片观察导管头端位置。结果 50例均一次性置管成功,平均置管时间(22.57±6.93)min,患者耐受性均良好,无消化道出血及穿孔发生。45例(45/50,90%)术后腹痛、腹胀明显缓解,平均缓解时间为(9.64±8.33)h。术后第1天负压引流量为(1 500±450)ml,第2天(750±120)ml,第3天(257±112)ml。术后第3天,导管平均进入长度为(195.97±14.63)cm,腹部X线片示导管头端位于远段空肠(第3组小肠);术后第6天,平均导管进入长度为(240.55±17.65)cm,导管头端位于远段回肠。平均肛门排气时间为(2.80±1.01)天,平均排便时间(3.52±1.26)天。结论 DSA引导下经鼻肠梗阻导管治疗难治性粘连性肠梗阻效果较好,可明显改善临床症状,恢复肠管生理功能。     

腹腔镜粘连松解治疗粘连性肠梗阻效果观察

目的分析腹腔镜粘连松解治疗粘连性肠梗阻的临床效果。方法将符合手术指证的80例粘连性肠梗阻患者随机分为2组,每组40例。观察组实施腹腔镜手术,对照组实施常规开腹手术。比较2组手术时间、术中出血量、术后肛门恢复排气时间和住院时间。结果 2组患者手术时间比较,差异无统计学意义(P0.05)。观察组术中出血量、术后肛门恢复排气时间及住院时间均少于对照组,术后并发症发生率和复发率小于对照组,差异有统计学意义(P0.05)。结论腹腔镜治疗粘连性肠梗阻,安全、有效且复发率低。     

经鼻肠梗阻导管置入术治疗单纯性粘连性肠梗阻35例临床分析

目的探讨经鼻肠梗阻导管置入术治疗腹部术后单纯性粘连性肠梗阻的方法及效果。方法选取2014-01—2017-01间在三门峡市中心医院接受经鼻肠梗阻导管置入术治疗的70例粘连性肠梗阻患者。在基础治疗的同时,根据不同胃肠减压方式分为2组,各35例。对照组采用传统鼻胃管胃肠减压,观察组采用经鼻肠梗阻导管置入肠减压。结果观察组患者术后胃肠减压量、术后腹痛缓解情况、肛门恢复排气及排便时间、住院时间均优于对照组,治疗总有效率显著高于对照组,差异有统计学意义(P 0. 05)。结论经鼻肠梗阻导管置入术治疗单纯性粘连性肠梗阻,症状改善迅速,成功率高。     

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??Comparative study of internal intestinal splinting with long nasointestinal tube vs traditional ileus surgery LIU Zhi-gang, SHANG Dong, BI Wei, et al. Third Department of General Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
Corresponding author: SHANG Dong, E-mail: shangdong@medmail.com.cn
Abstract Objective To evaluate the application value of internal intestinal splinting with long nasointestinal tube in management acute small bowel obstruction. Methods The clinical data of 129 cases of mechanical small bowel obstruction performed operation and followed up between April 2005 and December 2010 in the Third Department of General Surgery, the First Affiliated Hospital of Dalian Medical University were analyzed retrospectively. There were 41 cases in treatment group (internal intestinal splinting with long nasointestinal tube) and 88 cases in control group (traditional ileus surgery). Results There was no significant difference in the postoperative exhaust time or defecation time, the rate of postoperative complications and the postoperative mortality between the two groups (P>0.05). The postoperative recurrence rate of 5-years was 5.0% (2/40) in the treatment group, which was obviously less than the 18.8% (16/85) in the control group (P<0.05). And the recurrence time in the treatment group was (42.5±7.8) months, which was obviously less than (20.3±11.8) months in the control group (P<0.05). Conclusion The treatment of internal intestinal splinting with long nasointestinal tube has a good control effect on recurrence of acute small bowel obstruction.     

腹壁切口疝并发肠梗阻的易感因素分析及防治措施

目的探讨腹壁切口疝并发肠梗阻的易感因素及防治措施。 方法选取2013年2月至2018年10月,甘肃省人民医院收治的52例腹壁切口疝患者为研究对象,回顾性分析其临床资料,根据患者术后是否并发肠梗阻分为发生肠梗阻组（30例）与未发生肠梗阻组（22例）。比较2组患者一般资料及围术期相关指标,筛选出肠梗阻发生的易感因素,总结其防治措施。 结果发生肠梗阻组与未发生肠梗阻组在性别、是否合并急慢性支气管炎、是否合并前列腺炎方面比较,差异无统计学意义（P<0.05）。2组在年龄、手术类型、术前营养状况、切口类型、愈合类型、合并腹水及合并便秘者方面比较,差异无统计学意义（P>0.05）。发生肠梗阻组患者经治疗后腹痛消失时间为（3.40±1.78）d、腹胀消失时间为（4.24±1.57）d、排气时间为（5.96±1.61）d、进食流质时间为（6.95±2.02）d、胃肠减压引流量为（315.21±106.52）ml/d、平均住院时间为（14.59±2.63）d。 结论腹壁切口疝并发肠梗阻的易感因素为男性、合并急慢性支气管炎或前列腺炎,但肠梗阻经及时干预治疗后患者症状及体征均得以显著改善,提示重视易感因素的控制、及早给予治疗是防治肠梗阻的关键。     

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。     

Endoscopic decompression using a transanal drainage tube for acute obstruction of the rectum and left colon as a bridge to curative surgery

Objective  The aim of this study was to clarify the usefulness of the management of acute left colon and rectum obstruction because of colorectal carcinoma using a transanal ileus drainage tube before curative surgery.
Method  Forty-six patients (24 males and 22 females, aged 24–94 years, mean = 56.2) treated between September 2005 and March 2007 for acute left colon and rectal obstruction were identified in a colorectal obstruction database, and their clinical and radiological features were reviewed. After a cleaning enema was administered, urgent colonoscopy was performed. Subsequently, endoscopic decompression using a ileus tube was attempted.
Results  Endoscopic decompression using the ileus tube was technically successful in 45 of 46 patients (97.8%). Perforation occurred in one patient 3 days later and emergent operation was performed. The site of obstruction was the rectum in 15 patients, the sigmoid colon in 18, the descending colon in 13. Following adequate cleansing of the colon, patients' abdominal girth were decreased from 91 ± 4 cm before drainage to 82 ± 2 cm 7 days later, and one-stage surgery after 8 ± 1 days (SD; range 7–10 days) were performed. No anastomotic leakage or postoperative stenosis occurred after operation.
Conclusion  Management of acute left colon and rectum obstruction because of colorectal carcinoma using the ileus tube was found to be effective and safe, considered as a bridged method before curative surgery.     

肝硬化腹水合并脐疝的Onlay和腹膜前疝修补术对比研究

目的探讨在肝硬化腹水合并脐疝患者的外科治疗中Onlay术式和腹膜前疝修补术式治疗效果的差异。 方法回顾性分析2010年1月至2018年1月，上海交通大学医学院附属第一人民医院收治的肝硬化腹水合并脐疝25例患者的临床资料。根据术式不同分为2组，对照组患者13例行Onlay术式，试验组患者12例行腹膜前疝修补术。比较2组手术时间、排气时间、住院时间、伤口愈合情况及术后复发等观察指标，并进行统计学分析。 结果对照组平均手术时间（56.9±16.3）min，住院时间（8.7±5.8）d，排气时间（2.6±0.7）d。试验组平均手术时间（49.4±17.1）min，住院时间（10.8±4.7）d，排气时间（2.7±0.6）d。2组术后疼痛评分、伤口愈合情况等比较，差异均无统计学意义（P>0.05）。观察期内对照组出现轻微伤口感染患者1例，2组患者均未出现复发情况。 结论对于肝硬化腹水合并脐疝患者，Onlay和腹膜前疝修补两种术式在治疗效果可能无明显差异。     

腹腔镜与开腹手术治疗结直肠癌疗效比较

目的探讨腹腔镜与开腹手术治疗结直肠癌的手术效果。方法把62例结直肠癌患者随机分为常规开腹手术组(常规组)和腹腔镜下结直肠癌手术组(观察组)各31例。观察两组患者术后肛门排气时间、住院天数和肠梗阻的发生率,并对疗效进行评价。结果观察组患者术后肛门排气时间和住院天数均显著少于常规组。常规组20例结肠癌术后有6例发生肠梗阻,发生率为30.0%,观察组22例结肠癌术后有1例发生肠梗阻,发生率为4.55%。常规组11例直肠癌术后有2例发生肠梗阻,发生率为18.18%,观察组9例直肠癌术后有1例发生肠梗阻,发生率为11.11%。结论腹腔镜下结直肠癌手术创伤小,术后恢复快,肠梗阻的发生率较少。     

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??Clinical therapeutic effect of trans-anal ileus tube placement in acute obstruction result from left colorectal cancer LIU Qi , SU Ji, LUO Wei-zhen, et al. Department of General Surgery, the People’s Hospital of Hunan Province, Changsha 410005, China
Corresponding author: HUANG Zhong-cheng, E-mail: drliuqi@126. com
Abstract Objective To evaluate the clinical therapeutic effect of trans-anal ileus tube placement and drainage in acute obstruction result from left colorectal cancer. Method From Dec. 2007 to Jun. 2009, 29 patients of acute obstruction result from left colorectal cancer were admitted in the People’s Hospital of Hunan Province. 15 patients were received trans-anal ileus tube placement and drainage for 10 to 20 days before limited operation; and the other 14 patients were received emergency operation. The clinical effect, modus operandi, recovery effect, length of stay in hospital and the cost of hospitalization were observed in the two group patients. Result 15 patients were placed the trans-anal ileus tube successfully. Besides 1 patient’s tube prolapsed negligently after three days, the others rechecked the abdomen X-rays and founded the bowel obstructive signs disappeared before radical excision without abdominal stoma. The other 14 patients who received emergency operation needed further surgery treatment. Two group patients had no severer complications and the tube placement group had shorter length of total stay in hospital???25.90±2.46??d vs ??29.70±1.52??d??P<0.05??and the lower cost of hospitalization???27500.00±2163.5342????vs ??33200.00± 2512.4267??????P<0.05??. Conclusion Trans-anal ileus tube placement and drainage in acute obstruction result from left colorectal cancer could successfully avoid patients received surgical attack again. It was effective and safe and may be the first choice of clinical therapeutic.     

粘连性肠梗阻54例手术治疗体会

目的 探讨粘连性肠梗阻的手术指征和手术时机.方法 回顾性分析我院2002年9月～2006年9月手术治疗粘连性肠梗阻54例的临床资料.结果 本组54例全部治愈出院.术后发生伤口感染3例,术后5～7d再次出现梗阻者2例,均经保守治疗缓解.结论 急性粘连性肠梗阻的最佳手术时机应在肠绞窄发生之前.应用腹腔镜技术则手术指征可适度放宽.     

Stellenwert der intraluminalen Darmdekompression durch eine endoskopisch plazierte Dennis-Sonde in der Therapie des Ileus

For determination of the efficacy of intraluminal bowel decompression by an endoscopically placed Dennis tube, 174 patients with paralytic ileus or different kinds of partial small bowel obstruction were reviewed retrospectively. There were 66 cases (37.9%) of early post-operative ileus (A), 27 (15.5%) of late postoperative ileus (B), 38 (21.8%) of paralytic ileus (C), 31 (17.8%) with obstruction due to advanced intraabdominal tumors (D), and 12 (6.8%) of obstructive ileus caused by inflammatory stenosis of the small bowel in Crohn's disease (E). Successful endoscopic placement of the intestinal tube was achieved in 97.2% of patients. Placement of the tube was impossible in 5 cases. A total of 95 patients (54.6%) were successfully managed by long intestinal tube decompression. Success rates for the individual groups were 71.2% (A), 18.5% (B), 86.8% (C), 16.1% (D), and 41.7% (E). Some 75 patients (43.1%) had to be operated on because of insufficient conservative therapy. Four patients with advanced intraabdominal tumors died during the treatment with the intestinal tube; 13 patients died postoperatively. There was no tube-related mortality, but tube-related complications occurred in 6.9%. We conclude that intraluminal intestinal tube decompression after endoscopic placement provides a therapeutic tool with a concomitant low complication and high success rate in paralytic and early postoperative ileus.