腹腔镜探查肠粘连松解术治疗老年粘连性肠梗阻的有效性与安全性

目的探讨腹腔镜探查肠粘连松解术治疗老年粘连性肠梗阻患者的有效性与安全性。方法选择76例粘连性肠梗阻患者,根据入院时间分为观察组40例和对照组36例。对照组采用传统开腹手术治疗,观察组采用腹腔镜探查肠粘连松解术,比较两组手术相关指标、术后恢复、并发症及粘连复发情况、患者满意度。结果观察组手术时间、术中出血量、切口长度、止痛药物使用率均明显低于对照组(t或χ~2值=3.051,11.886,23.762,22.029,P0.05);术后下床时间、胃肠功能恢复时间、术后平均住院时间均明显短于对照组(t=7.834,11.357,10.381,P0.05);术后并发症、复发率均明显低于对照组(5.26%vs 23.68%,0.00%vs 15.79%,χ~2=5.208,6.514,P0.05);满意度(97.37%)明显高于对照组(84.21%,χ~2=3.943,P0.05)。结论腹腔镜探查肠粘连松解术能够减轻老年粘连性肠梗阻患者手术创伤,改善胃肠功能,降低术后并发症,提高患者满意度。     

甘露醇联合X线下经鼻小肠内导管排列术对急性小肠梗阻疗效观察

目的观察甘露醇联合X线下经鼻小肠内导管排列术对急性小肠梗阻的疗效。方法选取南阳市第二人民医院2012年6月-2014年6月收治的96例急性小肠梗阻患者为研究对象,采用随机数字表法将其分为试验组(48例)、对照组(48例),对照组给予基础治疗与X线下经小肠内导管排列术联合治疗,试验组在对照组的基础上给予甘露醇治疗,比较两组患者导管留置后减压效果、胃肠引流量、症状缓解时间、肛门排气时间、住院时间及不良反应情况。结果试验组患者胃肠引流量、症状缓解时间、肛门排气时间、住院时间显著低于对照组(P0.05);置管前两组患者的肠内压和症状评分相比,差异无统计学意义(P0.05);置管后两组患者的肠内压均显著降低,症状评分均显著增高,试验组优于对照组(P0.05);术后试验组不良反应发生率(4.17%)低于对照组(20.83%),差异有统计学意义(P0.05)。结论甘露醇联合X线下经鼻小肠内导管排列术可以有效改善患者的临床症状、缩短住院时间、减少不良反应,具有推广价值。     

老年患者行腹部手术后发生粘连性肠梗阻的危险因素及其治疗方法

目的探究老年患者行腹部手术后发生粘连性肠梗阻的危险因素及治疗方法。方法选取行腹部手术治疗的老年患者180例,依据是否发生术后粘连性肠梗阻将患者分为对照组和观察组。对比观察两组患者的一般因素、病理因素和手术相关因素,Logistic回归法分析老年患者术后发生粘连性肠梗阻危险因素。依据观察组患者具体病情,给予患者手术治疗。观察组患者随机分为A、B两组,A组给予腹腔镜手术治疗,B组给予开腹手术治疗,比较两组患者治疗效果和手术安全性。结果老年患者术后发生粘连性肠梗阻临床发生率为23.33%。阑尾切除术、结直肠癌根治术、肠吻合术、伴糖尿病、肿瘤患者TNM为Ⅲ~Ⅳ期、患者ASA为Ⅲ级、留置引流管和术后发生感染是老年患者腹部手术术后发生粘连性肠梗阻的相关危险因素。A组患者胃肠功能恢复时间和住院天数均显著低于B组患者(P0.05);A组患者手术时间短、术中出血量小、切口感染、肠壁损伤、再次肠梗阻发生率显著低于B组(P0.05)。结论老年患者腹部手术后发生粘连性肠梗阻是多因素共同作用的结果,对老年发生术后粘连性肠梗阻患者行腹腔镜手术治疗有利于患者尽快回复且不良反应发生率低。     

腹腔镜手术治疗粘连性肠梗阻术后快速康复护理研究

目的探讨快速康复护理用于腹腔镜手术治疗粘连性肠梗阻的临床价值。方法将我院86例行腹腔镜手术的粘连性肠梗阻患者按随机数表法均为观察组(快速康复护理)与对照组(常规护理),对比两组术后恢复肠蠕动时间、首次进食时间、住院时间,记录术后3 h、12 h、1 d、2 d、3 d疼痛评分及术后并发症发生率。结果观察组术后恢复肠蠕动时间(2.02±0.35)d、首次进食时间(3.57±0.76)d、住院时间(5.03±1.32)d均显著短于对照组(P0.05)。观察组术后3 h、12 h、1 d、2 d疼痛评分均显著低于对照组(P0.05)。术后3d两组疼痛评分比较无显著差异(P0.05)。观察组并发症发生率明显低于对照组(P0.05)。结论快速康复护理用于腹腔镜手术治疗粘连性肠梗阻可加速患者康复,有利于减轻术后疼痛程度,降低并发症发生率,临床应用价值高。     

腹腔镜肠粘连松解术应用于粘连性肠梗阻并糖尿病患者治疗效果评价

目的研究粘连性肠梗阻合并糖尿病用腹腔镜肠粘连松懈术的临床疗效。方法选择2015年10月—2017年4月该科接诊的粘连性肠梗阻合并糖尿病病患100例,同时采取数字抽签的方式对所选患者进行分组:试验和对照两组各50例。其中,试验组实施腹腔镜肠粘连松懈术治疗,对照组实施传统开腹手术治疗。观察两组术后病情的恢复情况,比较下床活动时间与并发症发生率等指标。结果试验组的手术时间、下床活动时间和住院时间都明显短于对照组,组间差异有统计学意义(P0.05)。试验组的并发症发生率为4.0%,明显比对照组的22.0%低,组间差异有统计学意义(P0.05)。试验组的术中出血量为(22.5±7.4)m L,明显比对照组的(148.3±30.9)m L少,组间差异有统计学意义(P0.05)。结论采用腹腔镜技术对粘连性肠梗阻合并糖尿病患者施以肠粘连松懈术治疗,可显著减少手术创伤,降低并发症发生率,改善预后,减轻术后疼痛,促进病情康复。     

直肠癌术后急性粘连性肠梗阻的中西医结合护理分析

目的分析直肠癌术后急性粘连性肠梗阻的中西医结合护理效果。方法选取我院2012年8月~2014年8月收治的急性粘连性肠梗阻患者60例,将其分为对照组和观察组,各30例。对照组实施西医常规护理,观察组在对照组的基础上实施中医护理,比较两组患者的疗效和护理效果。结果观察组总有效率为93.3%,显著高于对照组的73.3%;观察组肠鸣音恢复、症状消失、住院及肛门排便排气时间均明显短于对照组;差异均有统计学意义(P0.05)。结论直肠癌术后急性粘连性肠梗阻患者采用中西医结合护理,可明显提高疗效和护理效果,值得应用及推广。     

肠梗阻导管在老年患者术后早期粘连性肠梗阻中的应用效果

目的评价肠梗阻导管在老年术后早期粘连性肠梗阻中的应用价值。方法采用回顾性分析法,118例老年术后早期粘连性肠梗阻分为实验组60例实施肠梗阻导管胃肠减压治疗,对照组58例实施鼻胃管治疗,比较两组疗效。结果与对照组比较,实验组首个24 h消化液引流量、首个48 h腹围缩小程度等明显增加(P<0.01),肠鸣音、白细胞等恢复时间缩短(P<0.01),手术率明显降低(P<0.01),患者满意度增加(P<0.01)。结论肠梗阻导管治疗老年术后早期粘连性肠梗阻效果显著。     

胸腔镜辅助小切口治疗肺大疱的疗效观察

目的观察电视胸腔镜辅助小切口治疗肺大疱的临床效果。方法 87例肺大疱患者随机分为两组,对照组(n=42例)采用电视胸腔镜Endo-GIA治疗,观察组(n=45例)采用电视胸腔镜辅助小切口治疗,比较两组术中术后情况及围手术期并发症情况。结果观察组手术时间及住院总费用明显低于对照组(P0.05),呼吸困难改善时间明显快于对照组(P0.05),而在术中出血和术后住院时间方面比较无显著差异性(P0.05);观察组术后并发症发生率(17.8%)与对照组(19.0%)比较无显著差异性(P0.05)。结论胸腔镜辅助小切口治疗肺大疱手术时间短、临床症状改善快、住院费用低。     

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。     

肠内营养应用于糖尿病患者腹部手术后的效果观察

目的探讨肠内营养应用于糖尿病患者腹部手术后的效果。方法选取该院在2014年6月—2017年5月期间诊治的116例实施腹部手术治疗的糖尿病患者作为研究对象,按照随机的原则将患者平均分成两组,对照组采用常规输液营养方式治疗,观察组采用肠内营养方式治疗,观察和对比两组治疗效果。结果观察组肛门排气时间、住院时间明显短于对照组,住院费用明显少于对照组,两组对比差异有统计学意义(P0.05);治疗前两组患者的体重、Hb以及TP水平相比差异无统计学意义(P0.05),治疗后观察组显著改善,与对照组相比差异有统计学意义(P0.05);观察组并发症发生率为6.90%,明显低于对照组的20.69%,两组对比差异有统计学意义(P0.05);观察组术后一周血波动水平为(2.12±0.11)mmol/L,对照组患者术后1周血波动水平为(6.34±2.13)mmol/L,组间对比差异有统计学意义(P0.05)。结论对糖尿病行腹部手术治疗的患者,术后采用肠内营养方式治疗,可以取得更好的治疗效果,加快患者胃肠功能恢复的速度,值得临床推广和应用。     

Treatment of intestinal failure: intestinal transplantation

Over the past 15 years, intestinal transplantation for the treatment of intestinal failure has changed from a desperate last-ditch effort into a standard therapy for which a good outcome is expected. Patient survival after intestinal transplantation has improved in the past 3-5 years and now approaches that of other solid organ allograft recipients, including liver and kidney, and is similar to survival on permanent therapy with parenteral nutrition. Complications are more common and often more severe during the initial hospitalization period after intestinal transplantation than they are after transplantation of other solid organs. After intestinal transplantation the initial hospitalization period is, therefore, usually 3-8 weeks long. Nearly all patients discharged after intestinal transplantation have good allograft function and have been weaned from total parenteral nutrition. The cost of the initial hospitalization period is one to two times the cost of permanent total parenteral nutrition for 1 year, which means that, in most cases, intestinal transplantation is cost-saving within 2 years of transplantation. In addition, quality of life after intestinal transplantation, as determined by standardized quality of life measures, is good or normal.     

肠缺血再灌注时肠道菌群变化及胃肠多肽的作用

目的探讨肠缺血再灌注(IIR)后猕猴肠道菌群变化的原因。方法将10只健康成年猕猴分为对照组和IIR组,每组各5只。IIR组肠系膜上动脉夹闭60 min,松解再灌注24 h,造成缺血再灌注损伤。对照组行假手术。观察动物肠道大体形态改变,测定胃pH值;细菌培养分析回肠菌群的变化;免疫组化定位测定回肠局部胃肠多肽的分布,并用放射免疫分析法定量测定其水平变化,并在体外将胃肠多肽与肠道细菌共向孵育,观察两者有无相互作用。结果猕猴IIR损伤后,回肠内细菌较正常增加约106倍,以大肠杆菌等需氧菌为优势菌群;小肠明显充血扩张;胃内pH值由2.80±0.84增至7.20±0.84,伴有胆汁反流;全回肠组织中胃肠多肽(生长抑素、血管活性肠肽、P物质)明显增加,而黏膜中生长抑素及血管活性肠肽的浓度却减少;胃肠多肽与肠道细菌共同培养后,胃肠多肽的含量及细菌数量均无明显变化。结论猕猴IIR后,小肠细菌过度生长可能由小肠动力降低直接或间接导致。小肠肌间神经丛中的生长抑素及血管活性肠肽增加可能是此刻小肠动力降低的启动因素。     

Isolated intestinal transplantation for intestinal failure

OBJECTIVE: Parenteral nutrition sustains life in patients with intestinal failure. However, some experience life-threatening complications from parenteral nutrition, and in these individuals intestinal transplantation may be lifesaving. METHODS: This is a retrospective review of 28 consecutive isolated small bowel transplants performed in eight adults and 20 children between December 1993 and June 1998 at the University of Nebraska Medical Center. RESULTS: The 1-yr patient and graft survivals were 93% and 71%, respectively. The causes of graft loss were hyperacute rejection (n = 1), acute rejection (n = 5), vascular thrombosis (n = 1), and patient death (n = 1). The median length of time required until full enteral nutrition was 27 days. All 28 patients have experienced acute rejection of their small bowel grafts and rejection led to graft failure in five. Jaundice and/or hepatic fibrosis was present preoperatively in 17 of the 28 recipients and hyperbilirubinemia was completely reversed in all patients with functional grafts within 4 months of transplantation. Three patients developed post-transplant lymphoproliferative disease (11%). Three recipients developed cytomegalovirus enteritis and all were successfully treated. CONCLUSIONS: Patient survival after intestinal transplantation is comparable to parenteral nutrition for patients with intestinal failure. Better immunosuppressive regimens are needed to decrease the risk of graft loss from acute rejection. The incidence of posttransplant lymphoproliferative disorder is higher after intestinal transplantation than after other solid organ transplants and the risk of cytomegalovirus enteritis is low with the use of cytomegalovirus seronegative donors. Liver dysfunction in the absence of established cirrhosis can be reversed.     

Small intestinal bacterial overgrowth and intestinal permeability

Abstract

Objective. Capsule endoscopy (CE) is the gold standard to diagnose small bowel bleeding. The “suspected blood indicator” (SBI) offers an automated detection of active small bowel bleeding but validity of this technique is unknown. The objective was to analyze specificity and sensitivity of the SBI using the second small bowel capsule generation for the detection of active bleeding. Methods. This is a retrospective analysis of all patients (199) who attended our clinic for CE from June 2008 through March 2013. The second-generation PillCam SB 2 capsule was used for detection of (1) luminal blood content and (2) potentially responsible small bowel lesions. The findings of an independent investigator were correlated to SBI findings and a number of SBI markings were analyzed by a receiver operating characteristic (ROC). Results. In 157/199 cases, no sign of active bleeding or altered blood was detected. One hundred and thirty-seven of these 157 cases provided at least one SBI marking and a mean of 18.4 positive SBI markings per record were found. In 20 cases, neither SBI nor the human investigator detected abnormalities. Thirteen patients showed investigator-detected minor bleeding with mean SBI findings of 36 positive screenshots per record. When major bleeding was diagnosed by the investigator (n = 29), SBI detected a mean of 46.6 SBI-positive markings. SBI turned positive in 179 patients, whereas the investigator detected active bleeding in 42 cases. All patients with active bleeding were detected by SBI (sensitivity 100%, specificity 13%). ROC analysis revealed 51.0 SBI markings being the optimal cutoff for active versus no bleeding (sensitivity 79.1%, specificity 90.4%, misclassification of 15.3%). Conclusion. The new SBI software is a reliable tool to exclude active bleeding and/or major lesions but analysis of the CE video by a trained investigator is still important for the detection of lesions responsible for past bleeding.     

Comparative study of intestinal tuberculosis and primary small intestinal lymphoma

AIM:To characterize the clinical,radiological,endoscopic and pathological features of intestinal tuberculosis(ITB)and primary small intestinal lymphoma(PSIL).METHODS:This was a retrospective study from February 2005 to October 2012 of patients with a diagnosis of ITB(n=41)or PSIL(n=37).All patients with ITB or PSIL underwent computed tomography(CT)and pathological examination.Thirty-five patients with ITB and 32 patients with PSIL underwent endoscopy.These patients were followed for a further 18 mo to ascertain that the diagnosis had not changed.Clinical,endoscopic,CT and pathological features were compared between ITB and PSIL patients.RESULTS:Night sweating,fever,pulmonary TB and ascites were discovered significantly more often in ITB than in PSIL patients(P<0.05),however,abdominal mass,hematochezia and intestinal perforation were found significantly more frequently in PSIL than in ITB patients(P<0.05).Ring-like and rodent-like ulcers occurred significantly more often in ITB than in PSIL patients(P<0.05),however,enterorrhagia and raised lesions were significantly more frequent in PSIL than in ITB patients(P<0.05).The rate of granuloma was significantly higher in ITB than in PSIL patients(87.8%vs 13.5%,χ2=43.050,P<0.05),and the incidence of confluent granulomas with caseous necrosis was significantly higher in ITB than in PSIL patients(47.2%vs0.0%,χ2=4.034,P<0.05).Multi-segmental lesions,mural stratification,mural gas sign,and intestinal stricture were more frequent in ITB than in PSIL patients(P<0.05),however,a single-layer thickening of bowel wall,single segmental lesions,and intussusception were more common in PSIL than in ITB patients(P<0.05).Necrotic lymph nodes,comb sign and inflammatory mass were more frequent in ITB than in PSIL patients(P<0.05).The bowel wall enhancement in ITB patients was greater than that in PSIL patients(P<0.05),while the thickening and lymph node enlargement in PSIL patients were higher than those in ITB patients(P<0.05).CONCLUSION:Combined evaluation of clinical,radiological,endoscopic and pathological features is the key to differentiation between ITB and PSIL.     

Phasic study of intestinal homeostasis disruption in experimental intestinal obstruction

AIM: To investigate the phasic alteration of intestinal homeostasis in an experimental model of intestinal obstruction.METHODS: A rabbit model of intestinal obstruction was established by transforming parts of an infusion set into an in vivo pulled-type locking clamp and creating a uniform controllable loop obstruction in the mesenteric non-avascular zone 8 cm from the distal end of the ileum. The phasic alteration of intestinal homeostasis was studied after intestinal obstruction. The changes in goblet cells, intraepithelial lymphocytes, lamina propria lymphocytes, and intestinal epithelium were quantified from periodic acid-Schiff-stained sections. Ornithine decarboxylase (ODC) activity and serum citrulline levels were measured by high-performance liquid chromatography. Claudin 1 mRNA expression was examined by real-time polymerase chain reaction analysis. Intestinal microorganisms, wet/dry weight ratios, pH values, and endotoxin levels were determined at multiple points after intestinal obstruction. Furthermore, the number and ratio of CD3⁺, CD4⁺ and CD8⁺ T cells were determined by flow cytometry, and secretory IgA levels were measured with an enzyme-linked immunosorbent assay.RESULTS: A suitable controllable rabbit model of intestinal obstruction was established. Intestinal obstruction induced goblet cell damage and reduced cell number. Further indicators of epithelial cell damage were observed as reduced serum citrulline levels and claudin 1 gene expression, and a transient increase in ODC activity. In addition, the wet/dry weight ratio and pH of the intestinal lumen were also dramatically altered. The ratio of Bacillus bifidus and enterobacteria was reversed following intestinal obstruction. The number and area of Peyer’s patches first increased then sharply decreased after the intestinal obstruction, along with an alteration in the ratio of CD4/CD8⁺ T cells, driven by an increase in CD3⁺ and CD8⁺ T cells and a decrease in CD4⁺ T cells. The number of lamina propria lymphocytes also gradually decreased with prolonged obstruction.CONCLUSION: Intestinal obstruction can induce disruption of intestinal homeostasis.     

Validation of intramural intestinal microdialysis as a detector of intestinal ischaemia

Background: The purpose of this study was to validate intestinal microdialysis as a detector of intestinal ischaemia using measurements of glucose, lactate and glycerol from the jejunal wall. Methods: Based on a previous study, the cut‐off levels for the presence of regional intestinal ischaemia were defined for microdialysis glucose, lactate, glycerol and the lactate/glucose ratio. Changes of 60% in the metabolic compounds measured after 100?min were defined as the cut‐off level for ischaemia. The cut‐off levels were tested in a randomized, single‐blinded study. Ten pigs were used; occlusive ischaemia was performed by clamping a segment of the mesentery to the intestine. Four catheters were inserted per pig, two in the ischaemic segment and two in the non‐ischaemic segment. All catheters were numbered, randomly allocated and inserted in the intestine by the staff at the institute and unknown to the investigators. Results: One pig was excluded because the clamping was insufficient. Technical problems with the catheters were registered in 15% of cases owing to damage of the microdialysis membrane, dislocation, or incorrect placement. The predictive values of presence of ischaemia for glucose, lactate, glycerol and the lactate/glucose ratio were: 0.91, 1, 0.85 and 0.92, respectively. Conclusion: Using a 60% cut‐off limit measured after 100?min, intestinal ischaemia can be detected and excluded using intestinal microdialysis, but some technical problems remain that need further investigation.