超细内镜联合腹腔镜在急性左半结肠恶性梗阻中的应用

目的:评价超细内镜联合腹腔镜在急性左半结肠恶性梗阻应用中的安全性和有效性。方法:回顾性分析2013年1—9月收治的11例急性左半结肠恶性梗阻患者临床资料。先通过超细内镜引导下置入肠道支架,解除梗阻,再行腹腔镜结直肠癌根治一期吻合术。结果:11例患者均成功置入结肠支架,病变部位包括结肠脾区1例、降结肠2例、乙降结肠交界4例、乙状结肠2例、直乙状结肠交界2例。9例患者在支架置入后接受了根治性手术,2例因肝转移实施姑息性手术。术后1例切口感染,1例肺部感染,1例吻合口出血,均经保守治疗后好转。结论:术前肠道支架减压联合腹腔镜一期吻合手术是治疗急性左半结肠恶性梗阻安全有效的方法。     

结直肠癌伴急性肠梗阻的术式选择

目的探讨结直肠癌伴急性肠梗阻的外科处理方法。方法回顾性分析2002年1月至2008年6月手术治疗的结直肠癌伴急性肠梗阻31例的临床资料。结果31例均经手术治疗。右半结肠癌伴梗阻13例,其中12例行右半结肠一期切除,无吻合口漏发生,另1例癌肿不能切除行捷径手术;横结肠切除一期吻合2例;一期左半结肠切除肠吻合术7例,术后发生吻合口漏1例,其中2例乙状结肠癌伴梗阻行金属内支架置入,解除梗阻后3周行一期肿瘤切除肠吻合;Hartmann手术5例,术后恢复顺利,造口排便通畅,3～6个月后均进行了顺利关瘘手术;肿瘤无法切除行单纯结肠造口4例。结论重视围手术的处理,根据急性梗阻性结直肠癌病人全身情况和局部条件合理选择手术方式。     

微创外科技术在结直肠癌伴梗阻治疗中的临床应用

目的探讨记忆金属支架置入技术、腹腔镜手术及植入用缓释氟尿嘧啶局部化疗3种微创外科方法在治疗结直肠癌伴梗阻中的临床应用价值。方法对解放军第251医院、河北北方学院附属第一医院和第三医院2000年5月至2010年5月期间收治的68例结直肠癌伴梗阻患者分别采用下列2种方法治疗:①对可手术根治的结直肠癌伴梗阻患者,先在结肠镜引导下置入记忆金属肠管支架解除梗阻,施行暂时性过渡治疗,再经充分肠道准备后,腹腔镜下施行根治性切除手术;②对失去手术根治机会的晚期(TNMⅣ期)直肠癌患者,主要采用支架置入技术,施行永久性姑息治疗,并经支架网眼穿刺植入缓释氟尿嘧啶局部化疗。结果①采用支架置入技术施行过渡治疗,解除梗阻后采用腹腔镜手术52例,其中51例施行根治性切除,1例因侵袭、转移的乙状结肠癌未能切除。获随访41例,随访时间3~36个月,平均15个月。其中施行根治性切除40例,均无局部复发、切口肿瘤种植及吻合口狭窄,另1例未能切除者于术后93 d死亡。②对15例失去手术根治机会的晚期直肠癌和1例因患严重肺心病不能耐受手术的直肠癌,采用支架置入和植入用缓释氟尿嘧啶治疗,全部获随访,时间为3~24个月,平均14个月;现已死亡11例,其生存时间为(350±222)d(101~720 d);其余5例已存活3~13个月(平均9个月),未再发生肠梗阻。结论利用记忆金属支架与腹腔镜手术联合治疗可手术根治的结直肠癌伴梗阻患者,具有微创、安全等优点;利用记忆金属支架与植入用缓释氟尿嘧啶联合治疗失去手术根治机会的晚期直肠癌伴梗阻,可使患者避免结肠造口,延长其生存期。     

腹腔镜结直肠肿瘤手术18例报道

目的探讨腹腔镜结直肠肿瘤手术的安全性、有效性、手术方法及其应用价值。方法回顾性分析我院2007年6月至2008年3月期间18例结直肠肿瘤患者施行腹腔镜手术的临床资料和经验。结果本组中直肠癌5例，乙状结肠癌6例，乙状结肠息肉2例，降结肠癌和升结肠癌各2例，升结肠脂肪瘤1例。共15例手术顺利完成，其中施行Dixon手术4例，Miles手术1例，乙状结肠根治性切除5例，乙状结肠部分切除2例，左半结肠切除2例，右半结肠切除1例；3例患者因肥胖或肿瘤侵犯邻近器官而中转开腹手术，术中平均失血量约为110ml，平均清扫恶性肿瘤淋巴结数目13．5枚，术后肠功能恢复时间平均40h，平均住院时间9d，无手术死亡病例，无术后出血、吻合口漏等并发症。结论腹腔镜结直肠肿瘤手术具有创伤小、术后恢复快等优点，只要能严格把握适应证和熟练掌握腹腔镜技术，腹腔镜结直肠肿瘤手术安全、有效，具较好的应用前景。     

镍钛记忆合金支架与腹腔镜手术联合治疗结直肠癌伴肠梗阻34例分析

目的探讨结直肠癌伴肠梗阻微创治疗新方法。方法对结直肠癌伴肠梗阻34例患者,先在结肠镜引导下置入记忆合金肠道支架解除梗阻,再经充分肠道准备后,腹腔镜下施行根治性切除手术。结果 34例患者手术时间160～340min,平均210min;术后胃肠功能恢复时间2～4d,平均2.1d。术后出现吻合口漏1例,切口感染2例,经保守治疗治愈。TNMⅡ期患者5例,术后住院7～12d,平均8.2d;Ⅲ～Ⅳ期患者29例,术后5-FU/LV或FOLFOX4方案化疗。随访26例,时间3～36个月,平均15个月,1例死于广泛转移,其他25例无局部复发、切口肿瘤种植及吻合口狭窄。结论记忆合金支架与腹腔镜手术联合治疗结直肠癌伴肠梗阻具有微创、安全、恢复快、疗效好等优点,值得临床推广应用。     

经肛肠梗阻导管在左半结直肠肿瘤切除中的应用

目的：探讨腹腔镜联合经肛肠梗阻导管在左半结直肠肿瘤急性梗阻中的治疗价值。方法：将126例左半结直肠肿瘤急性梗阻病例随机分为2组,治疗组应用经肛肠梗阻导管行梗阻近段结肠减压、灌洗等治疗后,行腹腔镜手术并一期切除吻合;对照组按常规准备后手术治疗。结果：术后吻合口瘘发生率治疗组（1.6%）低于对照组（11.1%）,治疗组住院时间、总住院费用和术后第7 d血清白蛋白水平与对照组比较有显著性差异（P＜0.01）。结论：腹腔镜联合肠梗阻导管置入冲洗减压,在左半结直肠肿瘤急性梗阻中的应用安全、有效。     

腹腔镜辅助直肠支架置人术六例报告

目的探讨在腹腔镜辅助下直肠支架置入治疗不能切除的直肠癌伴梗阻的可行性和临床效果。方法回顾性分析2008年至2010年接受腹腔镜辅助直肠支架置入治疗的6例不能切除的直肠癌伴梗阻患者的临床资料。结果 6例患者均在腹腔镜辅助下成功安放直肠支架,平均手术时间27min（18～50min）,术后均有效解除梗阻,无支架移位、梗阻、肠出血、肠穿孔等并发症发生。结论腹腔镜辅助直肠支架置入治疗不能切除的直肠癌伴梗阻方法可行,能有效解除梗阻症状     

结直肠癌合并急性肠梗阻的外科治疗

目的 探讨结直肠癌并发急性肠梗阻的外科治疗方法及效果。方法 回顾性分析1993年7月至2003年7月间297例结直肠癌并发急性肠梗阻行急症手术治疗患者的临床资料。结果 右半结肠癌并梗阻103例，左半结肠癌和直肠癌并梗阻194例。其中一期切除吻合126例(右半结肠一期切除吻合98例，左半结直肠一期切除吻合28例)，全结肠切除或次全切除吻合者108例，Hartmann手术36例，Dixon手术9例，回乙状结肠或回直肠吻合捷径11例，肿瘤近端肠管造瘘7例。术后出现并发症53例(17．8％)，为切口感染、腹腔感染和肠瘘；死亡17例；280例(94．3％)痊愈出院。结论 一期切除吻合和结肠次全切除及全切除吻合手术治疗结直肠癌并发急性肠梗阻，是方便可行而安全有效的。     

非透视结肠自扩张金属支架置入过渡治疗急性梗阻性结直肠癌的临床分析

目的探讨非透视下结肠自扩张金属支架置入治疗急性梗阻性结直肠癌患者的安全性和有效性。方法回顾性分析2014年3月至2017年12月湖南省人民医院63例非透视结肠自扩张金属支架置入治疗急性梗阻性结直肠癌患者的临床资料。采用双人肠镜操作法,进镜至肿瘤部位后探寻狭窄孔并插入非血管腔道导丝,沿导丝将自扩张金属支架置入并通过狭窄段,释放支架于目的位置。结果 63例急性梗阻性结直肠癌患者中升结肠及结肠肝曲癌1例,横结肠癌2例,结肠脾曲癌6例,降结肠癌9例,乙状结肠癌29例,直乙交界及直肠癌16例。支架置入成功率100%,支架置入操作时间为5~35 min,平均(12.3±4.6)min。除1例严重感染合并水电解质酸碱平衡紊乱患者术后1 d死亡外,其余患者均术后第2 d进食流质饮食,2~4 d左右临床症状完全缓解,于术后2~3周手术治疗。结论非透视下结肠自扩张金属支架置入治疗急性梗阻性结直肠癌患者安全有效,是急性梗阻性结直肠癌由急诊手术向限期手术转变的有效过渡治疗手段。     

结直肠癌梗阻的内支架治疗

后作根治性手术,无伤口感染和吻合口瘘发生;另2例放置支架失败(1例由于梗阻位于脾曲,肿瘤太大;1例为位于降结肠的缩窄性肿块)。2例系姑息性永久性治疗,其中1例为直肠癌转移到卵巢、肝,合并大量腹水,第1次放置失败,再烧灼打隧道后放置成功;另1例为晚期胃癌盆腔转移,乙状结肠外侵受压。所有病例操作顺利,支架放置成功的患者无支架脱落和结肠穿孔,梗阻于24h内缓解。讨论国外文献报道,金属内支架治疗结直肠癌梗阻的成功率在85%～100%犤1-3犦。我们在金属内支架成功治疗食管狭窄的基础上,自行摸索结直肠癌梗阻放置国产内支架的方法,7例患者5例放…     

Restoration of myoelectrical propagation across a jejunal transection using microsurgical anastomosis

The aim of this study was to determine whether microsurgical anastomosis can restore propagation of jejunal pacesetter potentials (PPs) across a site of canine jejunal transection and preserve motility and transit in bowel distal to the transection. A complete jejunal transection with exact microsurgical anastomosis was performed in five dogs, while five dogs with intact jejunum and five dogs with complete transection and end-to-end conventional macrosurgical anastomosis were used as controls. Long-term recording electrodes and intraluminal, open-tipped pressure catheters were implanted in all dogs. The mean frequency of PPs decreased distal to the transection in both groups of transected dogs. However, aborad propagation of PPs across the anastomosis occurred episodically by 3 months in each dog that had a microsurgical anastomosis, but never occurred in any dog with a conventional macroanastomosis. Moreover, the motility and transit in bowel distal to the transection were unaltered in the dogs with a microsurgical anastomosis, whereas they decreased in the dogs with a macroanastomosis. The conclusion was that microsurgical anastomosis of transected canine jejunum restored episodic propagation of PPs across the anastomosis, and preserved motility and maintained transit in bowel distal to the anastomosis. The conventional macroanastomosis did none of these. Supported by the Mayo Foundation and the Nigrn Grant. Presented in part at the Thirty-Seventh Annual Meeting of The Society for Surgery of the Alimentary Tract, May 19–22, 1996, San Francisco, Calif.     

Successful laparoscopic‐assisted treatment of ileal endometriosis with intestinal obstruction

A patient in whom the laparoscopic procedure for intestinal endometriosis with small bowel obstruction was effective is reported. A 35‐year‐old woman who had complained of a stomach ache during menstruation had been followed up for 1 year at another hospital. She presented at Hiroshima Funairi Hospital with upper abdominal pain, and was admitted with suspected small bowel obstruction as a result of plain abdominal X‐ray showing abnormal intestine gas. Laparoscopic observation revealed marked adhesion and stenosis of the distal ileum, which were responsible for the obstruction. Mini‐laparotomy was selected and ilectomy and anastomosis were performed under laparoscopic‐assisted procedure. Histologically, endometriosis was confirmed and resection of the involved segment yielded excellent results, and the patient was discharged. This was an extremely rare case of intestinal obstructive involvement by endometriosis and we briefly discuss here the effectiveness of laparoscopic‐assisted operation. Chinese Abstract

Figure Chinese Abstract Open in figure viewer PowerPoint

Volume 6 , Issue 3 August 2002

Pages 94-96     

小肠内置管排列术治疗放射性肠炎合并肠梗阻

目的：探讨小肠内置管排列术治疗放射性肠炎合并肠梗阻的临床效果。方法：对12例放射性肠炎合并肠梗阻的患者进行小肠内置管排列术，其中2例行病变肠段切除，一期肠吻合术，其余10例行捷径手术，病变肠段旷置术。结果：全部临床治愈，主要并发症为肠瘘（25％）、腹腔感染（16．7％）。结论：放射性肠炎合并肠梗阻需手术治疗，捷径手术＋小肠内置管排列术是有效的手术方式，围手术期积极的营养支持是手术成功的保证。     

超声评分系统在粘连性肠梗阻严重程度评估中的应用价值

目的:建立粘连性肠梗阻的超声评分系统,并探讨其临床应用价值。方法:将肠管缺血性损害、肠管出现绞窄性改变、合并腹内疝、肠扭转和肠套叠等并发症、腹腔血性积液、肠管扩张程度、肠壁增厚伴肠腔缩窄,这6 项指标纳入超声评分系统,对124 例粘连性肠梗阻病例进行评分,并将评分结果与CT 及手术结果进行统计学比较。结果:124 例粘连性肠梗阻病例得分结果如下:最高分16 分,最低分4 分,平均(10±2.7)分,与手术结果对照,超声评分分值越高,严重程度越重,危险度越高。124 例粘连性肠梗阻中,超声与CT 对肠管缺血性损害的诊断符合率分别为80% 和70%,差异无统计学意义(P >0.05);超声与CT 对肠管出现绞窄性改变的诊断符合率分别为95.1% 和86.4%,对腹内疝、肠扭转或肠套叠的诊断符合率分别为46.7% 和82.2%,差异均有统计学意义(P <0.01);超声与CT 对腹腔血性积液的诊断符合率分别为46.7% 和60%,对肠管扩张程度的诊断符合率均为100%,对肠壁增厚伴肠腔缩窄的诊断符合率分别为72.1% 和69.8%,差异均无统计学意义(P >0.05)。结论:粘连性肠梗阻的超声评分系统可以帮助临床对粘连性肠梗阻的严重程度进行评估,可为临床医师制订治疗方案提供影像依据,从而有利于提高治愈率、减少死亡率。     

肝门静脉积气3例并文献分析

目的 总结分析肝门静脉积气(hepatic portal venous gas,HPVG)的产生原因、诊断及治疗.方法 回顾菏泽市立医院2018年3月至2019年10月诊治的3例HPVG病例,结合国内报道的HPVG病例,总结分析HPVG的临床特点、诊治经过和预后.结果 本组3例HPVG中1例由腹腔感染引起,1例由肠坏死...     

Difluoromethylornithine inhibits crypt fission

Crypt fission is a physiologic mechanism of crypt reproduction. It increases in pathophysiologic situations where intestinal regeneration is required (e.g., radiation injury). Polyamine metabolism is important in the regulation of intestinal growth and recovery from injury in response to a variety of stimuli. Our aim was to determine whether inhibition of polyamine synthesis by difluoromethylornithine (DFMO) influenced crypt fission. Forty-eight rabbits underwent patch enteroplasty in the terminal ileum. One group served as a control group and the other took 2 % DFMO orally. Animals (n = 6) from each group were killed at 7, 14, 21, and 28 days. Normal ileum adjacent to the enteroplasty was studied. Crypt dissection was performed 2 hours after vincristine was administered intravenously to determine crypt cell production rate, crypt depth, and proportion of bifurcating crypts (fission). DFMO administration decreased crypt fission (4 ±2% vs. 11 ± 2% and 13 ±1% vs. 34 ±4% at 7 and 14 days) compared to control animals. There was a corresponding increase in crypt depth at 14 and 21 days. Crypt cell production rate was similar in both groups and did not change with time. Mucosal ornithine decarboxylase activity (11.9 ±2.2 vs. 1.2 ± 0.3 specific activity at 21 days; P <0.05)and polyamine content (323 ±32 vs. 17±8 and 382 ±89 vs. 160 ±47 pmol/mg at 14 and 21 days, control vs. DFMO; P <0.05) were significantly lower in the DFMO group. The following conclusions were drawn: (1) DFMO administration inhibits crypt fission in stimulated intestinal epithelium; (2) this effect correlates temporally with reduced polyamine production; and (3) reduced crypt fission is another potential mechanism of inhibition of intestinal growth by altered polyamine metabolism. Presented at the Thirty-Ninth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, La., May 17–20, 1998.     

Evaluation of an improved ileus monitoring system for intestinal motility

To observe the recovery of normal intestinal movement and the effects of peristalsis-promoting agents in patients with intestinal obstruction, an ileus monitoring system using the balloon method was simultaneously compared with that using the infusion method in 24 patients. To initiate the balloon ileus monitoring system, measurement was started at a setting of 0 after connecting a transducer to the balloon inflation channel of a decompression tube. The recording sensitivity was 20 mmHg/cm, and the speed of recording was 5 mm/min. The sensitivity of the infusion method was found to be 0.70±0.17 times that of the balloon method, and therefore the balloon method was considered to be more accurate. The findings of this study show how useful this ileus monitoring system is for observing the motility of intestinal obstruction.     

Effects of Proanthocyanidins on Intestinal Motility Disturbance Following Intestinal Ischemia/Reperfusion

Purpose: To investigate the potential protective effects of Proanthocyanidins(PAs) on intestinal motility disturbance following intestinal ischemia/reperfusion (I/R). Materials and Methods: Male rats were divided into four groups: Sham, I/R, I/R+PA100 and I/R+PA200. Sham group underwent laparotomy without ligation, the others were subjected to intestinal ischemia for 1 h and reperfusion 4 h. Rats in the I/R+PA100 group received PAs (100 mg/kg/d) for 5 days prior to I/R, while rats in the I/R+PA200 group received PAs (200 mg/kg/d). After reperfusion, using an electrophysiology instrument measured ileal slow wave. Ileal specimens were obtained to determine contractility, tissue levels of Bax, Bcl-2, and Caspase-3 and evaluate histopathological changes. In addition, blood sample was obtained to determine serum superoxide dismutase (SOD) activity and malondialdehyde (MDA) levels. Results: Intestinal I/R caused severe histopathological injury including mucosal erosions, inflammatory cell infiltration, necrosis, and hemorrhage. Both PAs treatment decreased mucosal pathological impairment in comparison with the I/R group (p < .05) in light microscopic evaluations. In both PAs-treated groups, Bax and Caspase-3 expression were decreased compared to I/R group, while the Bcl-2 expression increased (p < .05), which was similarly the case for serum SOD activity demonstrated significant enhance (p < .05) and decline in MDA levels in comparison with I/R group (both p < .05). Moreover, PAs treatment was more efficient in attenuating serum MDA levels of intestinal I/R (both p < .05). And the contractile amplitude and frequency of slow wave in I/R+PA100 and I/R+PA200 groups were higher than I/R group (both p < .05). Conclusions: PAs improve intestinal motility disturbance following intestinal I/R by alleviating oxidative stress and apoptosis.     

再谈胃肠道术后早期炎性肠梗阻

诊断术后早期炎性肠梗阻时应重视复习病史,了解术中情况。放置小肠减压管并进行泛影葡胺造影,不但有助于排除其他原因导致的肠梗阻,而且有助于解除梗阻。对诊断不确定的肠梗阻进行非手术治疗时要多观察,注意病情恶化。术后早期肠梗阻如果需要行手术治疗,应遵循损伤控制性手术原则,以保全肠管、恢复肠内营养或经口饮食为目的。重视采用微创手术,开腹手术时减少对内脏的损伤,预防炎性肠梗阻的发生。     

大肠癌合并大肠息肉的外科治疗体会

为探讨大肠癌合并大肠息肉的手术处理方法及疗效,回顾分析56例大肠癌合并大肠息肉病例的诊治资料。结果显示,2004年3月至2009年7月收治的255例大肠癌患者中共发现并存大肠息肉者56例,其中45例行术前息肉摘除手术,7例行术中结肠息肉切除,4例在术后进行结肠息肉摘除。全组无手术并发症发生,息肉切除部位无残留、恶变或癌种植转移。结果表明,术前应用内镜切除是治疗大肠癌合并大肠息肉的主要手段;不宜内镜切除者,尽量采用扩大切除术;远离大肠癌常规切除范围、较分散的息肉和不宜扩大切除的患者,可在内镜定位下行局部切除,如为恶性息肉则行结肠次全或全切除。双镜联合可提高大肠息肉的诊治水平。