经鼻胃镜放置肠梗阻导管治疗粘连性小肠梗阻的临床应用

我们将鼻胃镜经鼻插入28例粘连性小肠梗阻的患者十二指肠降段,经活检孔引入亲水性超滑导丝至空肠,退出鼻胃镜,将肠梗阻导管沿导丝送入空肠上段,充盈前气囊后,观察患者治疗前后症状有无缓解、腹围缩小情况及24 h引流量等指标。结果 显示28例患者均1次置管成功,成功率100%。置管时间为10～35 min,留管时间为3～18 d。术中均无并发症发生。患者临床症状均有不同程度改善;24 h引流量480～1 550 mL,平均885 mL;置管24 h后患者腹围（79.1%±20.3%）显著小于置管前（100%,P〈0.05）。可见经鼻胃镜放置肠梗阻导管简便、易行,治疗粘连性小肠梗阻疗效确切,应作为治疗粘连性小肠梗阻的首选方法。     

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。     

经鼻肠梗阻导管置入术治疗老年患者术后粘连性肠梗阻效果观察

目的观察经鼻肠梗阻导管置人术治疗老年患者术后粘连性肠梗阻的效果。方法将60例术后粘连性肠梗阻老年患者随机分为治疗组和对照组各30例,均行禁食水、抗感染、抑酸、静脉营养及纠正水、电解质、酸碱平衡紊乱等对症支持治疗。对照组采用常规鼻胃管行胃肠减压,治疗组在DSA监视下行经鼻肠梗阻导管置入术,外接负压吸引器。结果治疗6d后,治疗组胃肠减压量平均为960ml,腹部症状缓解时间平均1．6d,恢复排气排便时间平均3．7d,气液平面消失时间平均6．4d,治愈28例（93％）;对照组分别为420ml、3．4d、5．6d、8．5d、19例（63％）。两组比较,P均〈0．05。结论经鼻肠梗阻导管置入术治疗老年患者术后粘连性肠梗阻安全有效,避免了老年患者行开腹手术。     

经鼻小肠减压管置入术在急性肠梗阻治疗中的应用

目的观察经鼻小肠减压管置入术在急性肠梗阻治疗中的应用效果。方法内镜或X线引导下经鼻小肠减压管置入行胃肠减压术治疗急性肠梗阻21例,X线检查观察导管造影情况,观察症状缓解情况。结果全部病例均一次性插管成功,无术中并发症发生。本组总有效率为90.48%(19/21),2例肿瘤性肠梗阻腹胀无明显缓解,中转手术治疗。所有病例均未出现穿孔和肠坏死。结论经鼻小肠减压管置入治疗急性肠梗阻疗效较好。     

肠梗阻导管在老年肠梗阻治疗中的应用

目的评价肠梗阻导管在老年肠梗阻治疗中的应用价值。方法回顾性分析2008年1月至2014年12月吉林大学中日联谊医院收治的86例老年肠梗阻患者的临床资料。对比分析肠梗阻导管组(41例)和鼻胃管组(45例)前2 d的胃肠减压量、腹胀改善情况(24 h腹围减少值)、整体有效率和手术率等临床指标。结果与鼻胃管组相比,肠梗阻导管组在24 h胃肠减压量、腹围减少值、整体有效率均有明显提高(P0.05),两组手术率无明显差异(P0.05)。在老年粘连性肠梗阻的治疗过程中,肠梗阻导管组较鼻胃管组的手术率明显降低(P0.05)。结论肠梗阻导管减压在老年肠梗阻尤其是老年粘连性肠梗阻的治疗中比常规鼻胃管减压疗效更确切有效。     

经鼻肠梗阻导管治疗术后早期炎性肠梗阻中的护理

目的探讨经鼻肠梗阻导管治疗术后早期炎性肠梗阻的有效护理措施。方法对26例术后早期炎性肠梗阻患者应用经鼻肠梗阻导管治疗并配合有效的护理措施,对治疗效果进行观察和分析。结果本组26例均经以经鼻肠梗阻导管治疗为主的综合治疗配合有效的心理护理、腹痛腹胀的观察、经鼻肠梗阻导管护理及并发症的预防及护理措施,全组病例于6~21 d(平均16d)治愈出院。结论经鼻肠梗阻导管治疗为主的综合治疗配合有效的护理措施是提高术后早期炎性肠梗阻治愈率的关键。     

肠梗阻导管在结肠癌性肠梗阻治疗中的疗效

目的 探讨肠梗阻导管在急性左半结肠癌性肠梗阻治疗中的临床效果.方法 我科于2007年6月-2007年9月收治2例急性左半结肠癌性肠梗阻病人,急诊肠镜并置入肠梗阻导管,通过肠梗阻导管冲洗管腔.结果 2例病人术后约30 min症状开始减轻,分别于术后17 h、23 h左右症状基本缓解,腹围缩小明显,分别缩小9 cm、12 cm.术后48 h腹部平片较术前明显好转,无并发症发生.术后1周行结肠癌Ⅰ期根治性切除吻合术,手术切口Ⅰ/A级愈合.结论 肠梗阻导管治疗左半结肠癌性肠梗阻操作简单、有效、经济,有临床应用的价值.     

超细胃镜引导下放置经鼻肠梗阻导管治疗肠梗阻26例

肠梗阻患者留置肠梗阻导管,比普通胃管更能有效地吸引肠内容物,降低肠管内压力,减轻水肿,恢复肠道血运及肠管动力,从而达到非手术解决肠梗阻的目的。临床上放置肠梗阻导管的方法很多,我院自2009年起采用超细胃镜引导下放置经鼻肠梗阻导管减压治疗肠梗阻,疗效满意,报道如下。     

成人粪石性急性小肠梗阻患者的早期诊治15例

目的:总结无胃手术史成人粪石性急性机械性小肠梗阻患者15例诊治经验.方法:2003-04/2008-04我院共收治成人粪石性急性机械性小肠梗阻患者15例,均无胃大部切除术史.所有患者行腹部平片检查和腹部CT扫描,并先予以保守治疗,2例老年人不能耐受手术,以内服发泡剂或纤维素酶治疗后缓解;保守治疗3 d后若肠梗阻症状无好转或逐渐加重后行手术治疗,11例行剖腹探查,2例行腹腔镜手术.结果:腹部平片检查均有大小不等的气液平面.腹部CT扫描均显示有肠内高密度粪石影.12例患者的粪石位于回肠,3例位于空肠.粪石的平均短轴直经是3.4 cm平均长轴直经是5.1cm.11例为单发粪石,占73.3%,4例为多发粪石,占36.7%.患者全部治愈,无并发症.结论:粪石性小肠梗阻多发于远端空肠和回肠.腹腔镜手术较传统开腹手术具有住院时间短、疼痛轻的优势.     

胃镜引导下经鼻肠梗阻减压管置入在小肠梗阻中的应用

目的探讨胃镜辅助下鼻肠减压管置人技术在小肠梗阻治疗中的作用。方法回顾分析我院2007年4月～2009年1月收治的13例小肠梗阻患者,在使用常规鼻胃减压管治疗无效后在胃镜辅助下放入鼻肠减压管,并进行胃肠减压治疗,观察置管效果并对疗效进行分析。结果胃镜辅助下鼻肠减压管置入平均时间19．4min,成功率100％,导管头端到达梗阻上方的平均时间4．3d,经造影观察均能明确病变部位并对病变性质作出初步判断;置管后病人腹痛、腹胀均有显著缓解,引流量增加,腹围减少;7例患者经减压治疗后小肠梗阻完全缓解,6例需手术治疗患者在手术治疗时均能依据导管头端位置准确定位。结论鼻肠减压管治疗小肠梗阻安全有效,应作为治疗小肠梗阻的首选方法;胃镜辅助置人鼻肠减压管操作简单,成功率高。     

Small intestinal obstruction resulting from ischemic enteritis: a case report

A 69-year-old male was admitted to our institution because of a sudden onset of vomiting and abdominal distention. His past history of illness included femoral head fracture, congestive heart failure and ischaemic colitis. Plain abdominal computed tomography revealed extensively dilated small intestinal loops with a calibre change around the end of the ileum. Small intestinal obstruction was diagnosed and a transnasal ileus tube was placed. The ileus tube was constantly moved towards small intestine until it reached the distal ileum. Contrast medium from the ileus tube revealed a distal ileal stricture. Subsequently, transanal single balloon enteroscopy was performed to inspect the stricture, revealing a circumferential and afferent tubular ulcer in the distal ileum, 5 cm from the ileocecal valve; gastrofluorography confirmed the stricture. Although the stricture was dilated on several occasions using balloon catheters, the stricture could not be improved. However, during the treatment, his general condition worsened over time; thus, surgical treatment was decided. Operative findings revealed several circumferential ulcers with a clear margin 5–28 cm from the ileocecal valve: all lesions were successfully resected. Pathological findings were consistent with ischaemic enteritis. We report a case of small intestinal obstruction resulting from stenotic ischaemic enteritis.     

Case of ileus due to an appendix epiploica]

A 79-year-old woman who had an abdominal pain and vomiting admitted to the hospital with a diagnosis of ileus. An ileus tube was inserted and the fluoroscopic study of the small intestine revealed narrowing of the two parts, jejunum and the ileum. Because no improvement was obtained by conservative treatment, an operation was performed. We observed that an appendix epiploica of the sigmoid colon extended long, and its tip was adherent to the retroperitoneum. The small intestine was impacted into the aperture formed by the band. Seventeen cases with intestinal obstruction due to an appendix epiploica have been reported in Japan, including this case.     

Ileus caused by cholesterol crystal embolization: A case report

Cholesterol crystal embolization(CCE) is a rare systemic embolism caused by formation of cholesterol crystals from atherosclerotic plaques. CCE usually occurs during vascular manipulation, such as vascular surgery or endovascular catheter manipulation, or due to anticoagulation or thrombolytic therapy. We report a rare case of intestinal obstruction caused by spontaneous CCE. An 81-year-old man with a history of hypertension was admitted for complaints of abdominal pain, bloating, and anorexia persisting for 4 mo. An abdominal computed tomography revealed intestinal ileus. His symptoms were immediately relieved by an ileus tube insertion, and he was discharged 6 d later. However, these symptoms immediately reappeared and persisted, and partial resection of the small intestine was performed. A histopathological examination indicated that small intestine obstruction was caused by CCE. At the 12-mo follow-up, the patient showed no evidence of CCE recurrence. Thus, in cases of intestinal obstruction, CCE should also be considered.     

A prospective randomized trial of transnasal ileus tube vs nasogastric tube for adhesive small bowel obstruction

AIM:To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction.METHODS:A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized controlled study.The endoscopically advanced new ileus tube was used for gastrointestinal decompression in 96 patients and ordinary nasogastric tube(NGT) was used in 90 patients.The therapeutic efficacy was compared between the two groups.RESULTS:Compared with the NGT group,the ileus tube group experienced significantly shorter time for relief of clinical symptoms and improvement in the findings of abdominal radiograph(4.1 ± 2.3 d vs 8.5 ± 5.0 d) and laboratory tests(P 0.01).The overall effectiveness rate was up to 89.6% in the ileus tube group and 46.7% in the NGT group(P 0.01).And 10.4% of the patients in the ileus tube group and 53.3% of the NGT group underwent surgery.For recurrent adhesive bowel obstruction,ileus tube was also significantly more effective than NGT(95.8% vs 31.6%).In the ileus tube group,the drainage output on the first day and the length of hospital stay were significantly different depending on the treatment success or failure(P 0.05).The abdominal radiographic improvement was correlated with whether or not the patient underwent surgery.CONCLUSION:Ileus tube can be used for adhesive small bowel obstruction.Endoscopic placement of the ileus tube is convenient and worthy to be promoted despite the potential risks.     

Gallstone ileus： Report of two cases and review of the literature

Gallstone ileus is a rare disease and accounts for 1%-4% of all cases of mechanical intestinal obstruction. It usually occurs in the elderly with a female predominance and may result in a high mortality rate. Its diagnosis is difficult and early diagnosis could reduce the mortality. Surgery remains the mainstay of treatment. We report two cases of gallstone ileus. The first was a 78-year old woman who had a 2-d history of vomiting and epigastralgia. Plain abdominal film suggested small bowel obstruction clinically attributed to adhesions. Later on, gallstone ileus was diagnosed by abdominal computed tomography (CT) based on the presence of pneumobilia, bowel obstruction, and an ectopic stone within the jejunum. She underwent emergent laparotomy with a one-stage procedure of enterolithotomy, cholecystectomy and fistula repair. The second case was a 76-year old man with a 1-wk history of epigastralgia. Plain abdominal film showed two round calcified stones in the right upper quadrant. Fistulography confirmed the presence of a cholecystoduodenal fistula and gallstone ileus was also diagnosed by abdominal CT. We attempted to remove the stones endoscopically, but failed leading to an emergent laparotomy and the same one-stage procedure as for the first case. The postoperative courses of the two cases were uneventful. Inspired by these 2 cases we reviewed the literature on the cause, diagnosis and treatment of gallstone ileus.     

成人美克尔憩室所致急性肠梗阻的临床特点

目的 分析成人美克尔(Meckel)憩室所致急性肠梗阻的临床特点和诊治体会.方法 对9例美克尔憩室所致急性肠梗阻病例的临床资料和病理学特点进行回顾性分析.结果 9例患者均行手术治疗,经腹腔探查证实为美克尔憩室所致急性肠梗阻.术前仅1例患者确诊为美克尔憩室所致急性肠梗阻,8例仅诊断为肠梗阻;5例行憩室楔形切除术,4例行包括憩室在内的部分回肠切除术.术后病理学检查显示9例患者美克尔憩室均有炎性改变,部分病例憩室伴有黏膜糜烂、微小溃疡、出血或穿孔,4/9憩室中含有异位组织;全部患者术后均痊愈.结论 美克尔憩室是导致急性肠梗阻的少见病因,术前诊断困难,易发生肠绞窄,部分病例憩室中含有异位组织,应及时手术治疗.

Abstract：

Objective To analyze the clinical features of adult patients with acute intestinal obstruction secondary to Meckel's diverticulum and the experience in management of the disease.Methods The clinical data and pathological features of 9 patients with acute intestinal obstruction secondary to Meckel' s diverticulum were retrospectively analyzed. Results All patients were diagnosed with acute intestinal obstruction secondary to Meckel's diverticulum via abdominal cavity exploration and underwent surgical treatment. Before surgical treatment, 1 out of 9 patients was correctly diagnosed as acute intestinal obstruction secondary to Meckel's diverticulum, and the other 8patients were diagnosed as acute intestinal obstruction. Diverticulum was resected in 5 cases and the rest 4 cases received partial excision of small intestine including the diverticulum. Pathological examination showed that all patients had inflammatory changes in diverticulum. Some patients were complicated with mucosal erosion, small ulcers, bleeding or perforation. Forty-four percent (4/9) of diverticula contained ectopic tissue. All patients were cured. Conclusion Meckel's diverticulum is a rare cause of acute intestinal obstruction and preoperative diagnosis is difficult. Diverticulum,howere,is likelihood to develop strangulation or contains ectopic tissue, so that the surgical treatment should be performed early.     

不明原因腹痛患者胶囊内镜检查的应用分析

目的探讨胶囊内镜在诊断不明原因腹痛的临床价值及安全性。方法将本院73例不明原因腹痛患者进行胶囊内镜检查,对检查结果进行分析。结果 73例患者中50例被检出小肠病变,检出率为68.49%。其中小肠克罗恩病6例、回肠多发性溃疡2例、小肠多发性毛细血管扩张1例、小肠息肉4例、小肠肿瘤1例、小肠寄生虫2例、小肠黏膜糜烂22例。12例分别为慢性浅表性胃炎、结肠炎、十二指肠溃疡。23例检查无异常。结论胶囊内镜操作简单、安全性高,对不明原因腹痛有较高的诊断价值。     

67例小肠克罗恩病的临床分析

背景：克罗恩病（CD）好发于末端回肠和回盲部,临床表现多种多样,但检查手段有限。目的：探讨小肠CD的临床特点和诊治情况。方法：回顾性分析2000年1月～2007年12月南京鼓楼医院收治的小肠CD患者的临床资料。结果：共纳入67例小肠CD患者,男女之比为4．15：1,诊断年龄13—79岁．其中20—29岁和50—59岁为两个发病高峰。临床症状主要表现为黑便或血便或脓血便43例（64．2％）、腹痛36例（53．7％）、贫血27例（40．3％）、腹泻26例（38．8％）。最常见的并发症为肠梗阻,穿孔少见。结肠镜下可见节段性病变、黏膜充血水肿、铺路石样改变等：胶囊内镜下表现为多发不规则溃疡、线样溃疡、阿弗他溃疡;手术病理活检示全壁性炎症、深裂隙状纵行溃疡、结节样肉芽肿。病变多位于末端回肠和（或）回盲部（49.3％）。接受胶囊内镜和结肠镜检查者经内科治疗后症状得到控制。14例患者因消化道出血、肠梗阻、穿孔而行手术治疗。结论：小肠CD的诊断较困难,可首选结肠镜检查。若无完全性肠梗阻可行胶囊内镜检查。与结肠镜和小肠造影检查相比．胶囊内镜对于早期小肠CD的诊断和患者病情的评估有一定优势,可推迟部分患者的第一次手术时间。     

Idiopathic abdominal cocoon syndrome with unilateral abdominal cryptorchidism and greater omentum hypoplasia in a young case of small bowel obstruction

Abdominal cocoon syndrome (ACS) is a rare cause of intestinal obstruction due to total or partial encapsulation of the small intestine by a fibrocollagenous membrane. Idiopathic ACS with abdominal cryptorchidism and greater omentum hypoplasia is even rarer clinically. We successfully treated a 26-year-old male case of small bowel obstruction with acute peritonitis. He was finally diagnosed with idiopathic ACS with unilateral abdominal cryptorchidism and greater omentum hypoplasia during exploratory laparotomy. He then underwent enterolysis, cryptorchidectomy, and appendectomy. He recovered gradually from the operations and early postoperative inflammatory ileus. There has been no recurrence of intestinal obstruction since the operation, and he is still in follow-up. We analyzed his clinical data and retrospectively reviewed the literature, and our findings may be helpful for the clinical diagnosis and treatment on ACS.