预置小肠内固定术的适应证和疗效

目的探讨预置小肠内固定术的适应证和治疗作用。方法选择严重腹部外伤、腹腔严重感染、广泛性粘连性肠梗阻,较大或较复杂的腹部手术,特别年老体弱、糖尿病患者,在结束腹部手术后,利用经过我们改制的小肠内固定管做预置小肠内固定术,术后早期经此管肠减压,灌注中药促进肠蠕动,肠功能恢复后行肠内营养。结果本组86例术后平均48～72h肠蠕动恢复,达到了较好的营养支持。无胃瘫、肠麻痹、粘连性肠梗阻等严重并发症发生,恢复顺利。结论选择适应证病例,加做预置小肠内固定术对预防术后严重并发症、促进顺利康复有很好的治疗作用。     

A case of the primary small intestinal cancer which performed operation under laparoscopy after ileus decompression

The patient was a 66-year-old man with repeated episodes of abdominal pain resulting in a diagnosis of ileus, and he was admitted to this hospital. During hospitalization, the pain symptoms improved after the insertion of an ileus tube, but there was a recurrence of ileus after the patient was started on a liquid diet. An adhesive intestinal obstruction was thus suspected, and laparoscopy was performed. A diagnosis of small intestinal carcinoma was made based on the intraoperative findings. A partial resection of the small bowel and a regional lymphadenectomy were performed through a minor laparotomy. The incidence of primary small intestinal cancer has been relatively rare, and it is difficult to differentiate the disease in most cases. A laparoscopy is considered useful to diagnose and treat ileus after decompression of the intestinal tract, and this article describes the case with some discussion.     

A case of pericecal hernia with a hernial orifice located on the lateral side of the cecum

The patient was a female in her 70s without previous laparotomy who visited our hospital for right lower abdominal pain. Marked small intestinal gas was noted on plain abdominal X-ray radiography. The patient was diagnosed with ileus and admitted. On contrast imaging through an ileus tube inserted for decompression, the small intestine was obstructed in the right lower abdominal region, and emergency laparotomy was performed. A hernial orifice was present on the lateral side of the cecum, and the small intestine was partially incarcerated, based on which a pericecal hernia was diagnosed. Since no circulatory disorder was noted in the incarcerated intestine, only reduction was performed without enterectomy. The hernial orifice was left open, considering that there was no possibility of re-incarceration. The postoperative course was favorable, and the patient was discharged on the 7th hospital day. Since this was a rare pericecal hernia case of internal hernia, we searched for and reviewed cases reported in Japan. This was a very rare case with a hernial orifice located on the lateral side of the cecum, not included in the current classification of pericecal hernia.     

泛影葡胺联合奥曲肽在粘连性肠梗阻治疗中的应用

目的探讨通过泛影葡胺胃肠道造影判断粘连性肠梗阻是否需要手术治疗以及联用奥曲肽保守治疗的效果。方法将120例患者随机均分为两组,对照组60例采用常规治疗方法;治疗组60例通过口服或胃管注入泛影葡胺80mL,行动态腹部X片观察以决定是否需手术治疗,不需手术者则联用奥曲肽治疗。结果总治愈率治疗组为80．00％,对照组为73．33％,两组无显著性差异（P〉0．05）;但治疗组胃管引流量明显减少,肛门第1次排气时间和平均住院时间明显缩短（P〈0．05）,且手术率也有所下降（治疗组为20．00％,对照组为26．67％）。结论泛影葡胺联合奥曲肽应用于粘连性肠梗阻有较好的诊治作用。     

结肠镜下金属肠道支架与经肛肠梗阻导管治疗左半结直肠癌急性梗阻的临床研究

【摘要】目的 探讨结肠镜下金属支架与经肛肠梗阻导管治疗左半结直肠癌急性梗阻的临床疗效。方法 回顾性研究我院2011年8月至2013年12月,符合诊断标准的左半结直肠癌急性梗阻患者共80例,分为支架组和导管组,各40例。两组均在结肠镜并X线辅助下进行,支架组放置金属肠道支架治疗,导管组经肛放置肠梗阻导管治疗。待梗阻消失后（7~10d）,患者行一期肿瘤根治性切除并吻合。对比研究两组技术操作、肠梗阻改善情况以及手术治疗效果。结果 两组技术上相比,支架组成功率为87.5%,导管组为97.5%,P>0.05,无统计学差异,且均未出现并发症;但支架组操作时间及费用均明显高于导管组。从梗阻缓解情况相比,两组患者梗阻缓解率分别为100%和95%,P>0.05,但导管组2例患者因梗阻未能缓解,行急症手术治疗。此外,支架组梗阻缓解时间及C反应蛋白差值均优于导管组。梗阻缓解后,两组患者行一期肿瘤根治切除并吻合,均未出现吻合口瘘。并且手术时间、切口感染率和住院时间也无显著差异。结论 上述两种方案均可作为治疗左半结直肠癌急性梗阻的安全有效手段,并能达到一期根治性切除和吻合,降低围手术期并发症发病率。但经肛肠梗阻导管治疗卫生经济学价值更优;而从肠梗阻改善情况角度考虑,选择肠道金属支架在一定程度上优于经肛肠梗阻导管。     

彩色多普勒超声检查在小儿肠套叠诊断和治疗中的作用

目的 探讨高频彩色多普勒超声检查对小儿肠套叠的诊断价值,并根据套叠肠管及其肠系膜血管的血流动力学情况选择复位治疗方式,进行疗效观察.方法 对377例可疑肠套叠患儿进行高频彩色多普勒超声检查,确诊肠套叠后,重点观察套叠肠管及其肠系膜血管的血流动力学情况,并依此选择进行水压灌肠复位治疗.结果高频彩色多普勒超声确诊肠套叠263例,诊断符合率100%,其中选择水压灌肠复位成功253例,复位成功率96.2%;10例复位失败后改手术治疗,失败组套叠肠管肠壁严重水肿,无血流显示.结论 高频彩色多普勒超声诊断小儿肠套叠准确率高.根据套叠肠管及其肠系膜血管的血流动力学情况可将肠套叠分三种类型:Ⅰ型即肠管肠壁血流信号增加或正常,应用水压灌肠复位;Ⅱ型即肠管肠壁血流较少且阻力指数偏高,尽量试用水压灌肠复位;Ⅲ型即肠壁严重水肿,阻力指数显著升高,无血流显示,禁忌水压灌肠复位,应尽快手术治疗.     

经肛型肠梗阻导管治疗结肠恶性梗阻患者的临床研究

目的探讨经肛型肠梗阻导管减压治疗结肠恶性肠梗阻患者的临床疗效。方法对30例结肠恶性梗阻患者予以经肛型肠梗阻导管减压治疗,观察梗阻症状缓解情况。结果29例患者置管成功,2d内梗阻症状均获明显缓解,术前腹围较置管前明显减小,经7～14d减压后均顺利进行I期手术,术后恢复良好,随访无不良并发症发生。结论经肛型肠梗阻导管减压治疗结肠恶性梗阻有效、简便,值得临床推广应用。     

腹部手术后早期炎性肠梗阻40例诊治体会

目的 探讨术后早期炎性肠梗阻的病因、临床特点、诊断与治疗.方法 我科2006年6月-2011年6月收治腹部手术后早期炎性肠梗阻40例,根据临床特点采取个体化的综合疗法.结果 40例中38例均经非保守治疗痊愈,平均治愈时间15 d;2例分别因发生机械性肠梗阻、肠绞窄后中转手术治愈.结论 术后早期炎性肠梗阻好发于腹腔污染重或创伤大的腹部手术,多发生于术后1～2周,有典型的肠梗阻症状和体征,绝大多数患者经保守治疗有效,仍有极少数患者可发生机械性肠梗阻或肠绞窄,须手术治疗方能痊愈.     

16排螺旋CT对小肠间质瘤的诊断价值

目的评价16排螺旋CT对小肠间质瘤的诊断价值。方法回顾性分析我院2009年1月至2009年12月期间30例经手术病理证实小肠间质瘤的患者行16排螺旋CT表现。结果良性间质瘤表现为肿块密度均匀,边缘光滑。增强扫描肿块呈轻度至明显强化,肿块强化以静脉期明显。恶性间质瘤表现为不规则软组织肿块,主要向腔外突出,密度不均匀,中央密度低,增强扫描呈不均匀强化,边缘强化明显,中央见低密度坏死区不强化。结论 16排螺旋CT扫描检查对小肠间质瘤的定位、定性诊断具有重要价值。     

老年患者术后粘连性肠梗阻应用经鼻肠梗阻导管置入术治疗的临床体会

目的 探讨老年患者术后粘连性肠梗阻应用经鼻肠梗阻导管置入术治疗的临床效果。方法 选取本院2012年1月～2013年1月收治的96例术后粘连性肠梗阻老年患者,随机将其分为观察组和对照组,各48例。对照组给予传统常规鼻胃管胃肠减压术治疗,观察组给予经鼻肠梗阻导管置入术治疗,比较两组的总有效率及症状改善情况。结果 观察组的总有效率明显高于对照组,腹围减少及胃肠减压引流量情况均明显优于对照组,排便排气恢复时间及气液平面消失时间均明显短于对照组（P〈0．05）;观察组的转手术治疗率明显低于对照组（P〈0．05）。结论 给予术后粘连性肠梗阻患者经鼻肠梗阻导管置入术治疗可有效提高治疗效果,改善患者的临床症状,临床效果显著,值得推广和应用。     

Improved motility in the gastrointestinal tract of a postoperative ileus rat model with ilaprazole

Postoperative ileus (POI), a symptom that occurs after abdominal surgery, reduces gastrointestinal motility. Although its mechanism is unclear, POI symptoms are known to be caused by inflammation 6 to 72 h after surgery. As proton pump inhibitors exhibit protective effect against acute inflammation, the purpose of this study was to determine the effect of ilaprazole on a POI rat model. POI was induced in rats by abdominal surgery. Rats were divided into six groups: control: normal rat + 0.5% CMC-Na, vehicle: POI rat + 0.5% CMC-Na, mosapride: POI rat + mosapride 2 mg/kg, ilaprazole 1 mg/kg: POI rat + ilaprazole 1 mg/kg, ilaprazole 3 mg/kg: POI rat + ilaprazole 3 mg/kg, and ilaprazole 10 mg/kg: POI rat + ilaprazole 10 mg/kg. Gastrointestinal motility was confirmed by measuring gastric emptying (GE) and gastrointestinal transit (GIT). In the small intestine, inflammation was confirmed by measuring TNF-α and IL-1β; oxidative stress was confirmed by SOD, GSH, and MDA levels; and histological changes were observed by H&E staining. Based on the findings, GE and GIT were decreased in the vehicle group and improved in the ilaprazole 10 mg/kg group. In the ilaprazole 10 mg/kg group, TNF-α and IL-1β levels were decreased, SOD and GSH levels were increased, and MDA levels were decreased. Histological damage was also reduced in the ilaprazole-treated groups. These findings suggest that ilaprazole prevents the decrease in gastrointestinal motility, a major symptom of postoperative ileus, and reduces inflammation and oxidative stress.     

The relationship between gastrointestinal transit and motility in dogs with postoperative ileus

We investigated the relationship between gastrointestinal (GI) transit and motility during postoperative ileus in dogs undergoing a single laparotomy. We combined X-ray radiography for a GI transit study with chronically implanted force transducers (FTs) for a GI motility study. Radio-opaque markers made of polyethylene and steel wires or barium sulfate were used to examine solid substance transit or liquid substance transit. For a while after the end of the operation, postoperative ileus was observed, with weak irregular contractions of the GI tract. Transmission of the contractions to the lower GI tract was then observed. The start point of interdigestive migrating contraction (IMC)-like motility was observed in the order of small intestine (I-IMC), duodenum (D-IMC), and stomach (G-IMC), and IMC proceeded gradually after the operation. The gastric emptying time of a solid marker was 73.6 +/- 2.3 h (n = 5), and depended on the time of first occurrence of G-IMC (r = 0.674, p = 0.006). The gastric emptying of the liquid marker was finished before the time of the first occurrence of G-IMC, and its small intestinal transit time correlated with the time of the first occurrence of G-IMC (r = 0.888, p = 0.018). Using combined X-ray radiography and FTs we found that recovery from postoperative ileus was aided by GI motility in which contractions were transmitted from the stomach to the lower GI tract, like IMC.     

后早期炎性肠梗阻27例的临床特点及诊治分析

目的探讨术后早期炎性肠梗阻的特点和诊断、处理方法。方法回顾性分析1998年1月至2008年5月治疗的27例术后早期炎性肠梗阻的临床资料。结果27例均经胃肠减压,应用生长抑素、肠外营养等支持疗法,平均治愈时间为14．5d,无一例再手术。结论术后早期炎性肠梗阻的诊断主要依靠病史、体征及腹部X线、CT检查。术后早期炎性肠梗阻可表现为典型的肠梗阻体征,多由小肠无菌性炎症致广泛肠粘连引起,多数病例采用保守治疗,肠绞窄或有肠绞窄趋势应及时手术。     

螺旋CT在肿瘤性肠梗阻诊断中的应用价值

目的探讨螺旋CT用于肿瘤性肠梗阻诊断的应用价值。方法回顾性分析我院2012年10月,2013年6月经手术证实为肿瘤性肠梗阻且术前均行腹部x线平片和CT扫描两种检查的32例患者的临床资料,对两种检查方法的检查结果进行比较分析。结果（1）两种诊断方式在梗阻诊断率、梗阻病因诊断率、梗阻部位诊断率以及绞窄的诊断率上比较有明显差异（P〈0．05）;（2）CT诊断结果与术后病理TNM分期结果比较无显著性差异（P〈0．05）。结论螺旋CT用于诊断肿瘤性肠梗阻效果显著,且能够有效提高梗阻诊断率,明显优于腹部x线平片检查。     

中药排气汤对术后肠梗阻小鼠胃肠功能的作用及机制研究

目的:研究中药排气汤对术后肠梗阻小鼠胃肠功能的作用及机制。方法:取7周龄SPF级C57BL/6J小鼠24只,随机分为假手术组、模型组、莫沙必利组、排气汤组,每组6只,采用经典小肠干扰术诱导小鼠术后肠梗阻模型。手术24 h后观测各组小鼠胃肠运动功能、肠道组织结构,ELISA试剂盒检测小鼠血清促炎因子白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和抗炎因子白细胞介素-10(IL-10)的水平,免疫组织化学法检测小鼠小肠Cajal间质细胞(interstitial cells of Cajal, ICC)及诱导型一氧化氮合酶(inducible nitric oxide synthase, iNOS)的表达情况,Western Blot检测小鼠小肠中Toll样受体4(TLR4)、活化丝裂原激活的蛋白激酶p38(p38MAPK)和核转录因子-κB p65(NF-κB p65)表达水平。结果:与假手术组相比,模型组小鼠小肠推进率显著下降(P<0.01),血清炎症因子含量明显升高(P<0.05);与模型组相比,排气汤组小鼠小肠推进率明显升高(P<0.05),血清中炎症...     

应用肠梗阻导管治疗术后早期炎性肠梗阻

目的探讨肠梗阻导管在术后早期炎性肠梗阻治疗中的应用价值。方法将2005年6月至2012年6月我院普外科住院病例46例,随机分为2组:A组(应用肠梗阻导管减压组);B组(应用鼻胃管减压组)。均采用常规保守治疗,包括禁食水、纠正水电解质紊乱和酸碱平衡紊乱,全胃肠外营养及应用抗生素。观察比较两组治疗前后临床症状及体征改善情况、胃肠减压量、腹部影像学改变和自主排气、排便时间,对相关数据进行统计学分析。结果本组46例患者均经保守治疗后治愈,A组与B组相比较,腹胀腹痛缓解时间分别为(2.8±1.5)d和(5.2±1.6)d(t=3.191,P=0.004),自主排气排便时间为(6.3±2.8)d和(10.5±3.5)d(t=2.815,P=0.012),CT恢复改变时间(6.8±2.3)d和(9.2±2.9)d(t=5.016,P=0.013),胃肠减压有效率A组与B组相比较P<0.05,差异有统计学意义。结论在常规保守治疗过程中,应用肠梗阻导管能够加速改善术后早期炎性肠梗阻患者梗阻症状,缩短治疗进程,是值得推广的有效治疗方法。     

胃肠道间质瘤的影像学表现及诊断

目的探讨胃肠道间质瘤（GIST）的影像学表现、病理学特点及诊断方法。方法回顾性分析14例经手术及病理证实的GIST患者临床、病理及影像学资料。结果14例GIST均为单发,位于胃10例,小肠4例。肿瘤多为圆形、类圆形,少数为分叶状不规则形。免疫组化检查：CD117（＋）12例,CD34（＋）9例。结论影像学检查对GIST的诊断及定位有重要价值,但最后确诊有赖于病理组织学检查。     

多层螺旋CT诊断肠梗阻的临床价值

目的探讨多层螺旋CT（MSCT）对急性肠梗阻的诊断价值。方法对50例临床疑似肠梗阻的患者,应用多层螺旋cT扫描,并将其诊断结果与手术、病理进行对照。结果MSCT诊断肠梗阻存在的正确率96％（48／50）、敏感性95％（41／43）、特异性92％（46／50）;X线立卧位平片诊断有无肠梗阻存在的正确率66％（33／50）,敏感性76％（33／43）、特异性68％（34／50）;经手术或随访证实的17例cT检查病因诊断正确率82％（14／17）、定位诊断正确88％（15／17）;小肠手术诊断与cT的符合率无显著性差异（χ2=2．78,P〉0．05）,结肠手术诊断与cT的符合率有显著性差异（χ2=23．95,P〈0．05）。结论多层螺旋cT扫描多平面重建成像能更清晰地显示急性肠梗阻病变,提高了cT对急性肠梗阻病因的诊断能力。     

通腑化瘀汤对术后肠梗阻大鼠肠组织COX-2及Cajal间质细胞表达的影响

目的建立术后肠梗阻大鼠模型,观察通腑化瘀汤对术后肠梗阻大鼠肠组织环氧化酶-2(Cyclooxygenase-2,COX-2)及Cajal间质细胞(Interstitial cells of Cajal,ICC)表达的影响,评估肠粘膜损伤程度,为临床更好地防治术后肠梗阻提供有效的治疗方剂和理论依据。方法取健康雄性SD大鼠45只,随机分为通腑化瘀汤组(药物组)、生理盐水对照组(对照组)、空白组,药物组和对照组给予开腹手术建立术后肠梗阻模型,手术后6、16 h时间点分别给予通腑化瘀汤药液和生理盐水各0.8 m L灌胃,空白组不给予手术处理。处死前取大鼠小肠远端距盲肠约5 cm的肠组织,采用HE染色显微镜下观察肠粘膜损伤情况;免疫组织化学方法检测c-kit蛋白(ICC特异性标志物)和COX-2蛋白的平均光密度值。结果对照组与空白组相比,COX-2表达显著提高(P<0.05),c-kit表达显著降低(P<0.05),肠黏膜损伤程度较重;药物组与对照组相比,COX-2表达显著降低(P<0.05),c-kit表达显著提高(P<0.05),损伤的肠粘膜得到一定程度修复。结论通腑化瘀汤能够减少术后肠梗阻小肠组织COX-2的表达,改善ICC形态并提高ICC数量,抑制炎症反应,对受损伤的肠粘膜起到保护作用。     

腹部手术后早期炎性肠梗阻27例诊治分析

目的：探讨腹部手术后早期炎性肠梗阻的临床诊断及治疗措施。方法：回顾性分析我院27例腹部手术后早期炎性肠梗阻的临床特点及治疗方法。结果：26例采用胃肠减压、肠外营养、糖皮质激素、生跃抑素等非手术方法治疗，1例手术治疗，均获痊愈，平均治愈时间为12．6天。结论：术后早期炎性肠梗阻多发生在腹部手术后1～2周，临床上有典型的肠梗阻症状和体征，手术治疗操作困难且易引起并发症，应采用非手术方法治疗，同时应严密观察病情变化，防止出现肠绞窄。