不同肠道准备法的清洁效果与切口细菌状况的实验研究

目的探讨不同肠道准备方法对肠道手术肠管清洁效果与切口细菌状况的影响。方法将60只实验大鼠采用随机数字表法分为三组各20只,分别采用50%硫酸镁导泻联合0.1%肥皂水灌肠法(A组)、聚乙二醇电解质散剂灌胃(B组)、甘露醇灌胃(C组)进行术前肠道准备。结果术中三组都观察到结肠内空虚、清洁、管腔塌陷。A组细菌计数(3 220.0±311.2)个、B组细菌数(2 224.0±347.8)个、C组细菌数(2 524.0±296.7)个;A组肠道术口细菌数显著高于B组及C组(均P0.01),而B组与C组术口细菌数比较,差异无统计学意义(P0.05)。结论聚乙二醇电解质散剂和甘露醇灌胃顺行清洁肠道,对清除肠腔细菌效果好于硫酸镁导泻联合肥皂水灌肠。     

聚乙二醇电解质散溶液用于胃癌术前肠道清洁的临床观察

目的 探讨胃癌患者术前肠道清洁的有效方法.方法 将120例术前需肠道清洁的胃癌患者随机分为观察组和对照组各60例,观察组术前口服聚乙二醇电解质散溶液,对照组常规口服甘露醇溶液.结果 观察组灌肠次数显著少于对照组(P＜0.01),肠道清洁获佳率显著高于对照组(P＜0.05),术后首次排气、排便时间显著早于对照组(均P＜0.01).结论 口服聚乙二醇电解质散溶液用于术前肠道清洁效果理想,且胃肠功能恢复快,无并发症发生.     

结直肠手术前3种机械肠道准备药物的临床效果比较

为探讨口服磷酸钠溶液与复方聚乙二醇电解质散剂行肠道准备的安全性和实用性,将60例结直肠手术患者随机分为3组,分别采用口服磷酸钠溶液（SP组）、复方聚乙二醇电解质散剂（PEG组）和甘露醇组行手术前的肠道准备,观察每组肠道准备前后的血清学指标,肠道清洁程度,患者对药物的耐受性以及手术前后患者的一般情况。3组肠道准备方法在患者的血清学指标,肠道清洁程度等方面无显著性差异,但甘露醇组的腹泻次数明显多于SP组及PEG组,且耐受性较低。结果表明,口服磷酸钠溶液及复方聚乙二醇电解质散剂肠道准备法是安全、可靠的,具有较好的实用价值。     

3种肠道清洁方法效果比较

目的 探讨不同肠道清洁方法用于放大肠镜检查与治疗的效果.方法 将1 296例接受放大肠镜检查与治疗的患者随机分成甘露醇组(378例)、复方聚乙二醇电解质散组(431例)和大肠水疗组(487例),分别采用口服甘露醇、口服复方聚乙二醇电解质散和大肠水疗法进行肠道准备.比较肠道清洁效果和恶心、呕吐、腹痛等不良反应的发生率.结果 大肠水疗组和复方聚乙二醇电解质散组的肠道清洁有效率显著高于甘露醇组(均P＜0.0125);三组恶心、呕吐发生率比较,差异有显著性意义(均P＜0.0125).结论 大肠水疗法的肠道清洁效果明显优于口服甘露醇,不良反应少,但费用较高;复方聚乙二醇电解质散肠道清洁效果与大肠水疗法相似,不良反应相对少.应根据患者的实际情况及经济能力选择最佳的肠道准备方法.     

复方聚乙二醇电解质散应用于混合痔患者术前肠道准备的临床观察

目的 比较复方聚乙二醇电解质散和甘露醇应用于混合痔患者术前肠道准备的效果和使用体会。方法 回顾性分析从2017年1月至2017年6月我医院收治的64例混合痔患者,根据患者术前肠道准备口服复方聚乙二醇电解质散者为观察组,32例;口服20%甘露醇注射液肠道准备者为对照组,32例。观察两组患者的手术效果和术后并发症,以及口服药物后首次排便时长、术后肛门排气时长以及不良情况发生率。结果 观察组患者首次排便时长为2.31±0.54h,对照组的为4.04±0.55h,P<0.001;观察组患者术后肛门排气时长为17.03±1.60h,对照组的为20.19±1.38h,P<0.001;观察组患者不良情况1例,发生率为3.1%,对照组的为8例,25.0%,P=0.031。结论 混合痔患者术前予以口服复方聚乙二醇电解质散肠道准备效果良好,且能有效地促进肠道功能恢复,副作用少。     

结直肠癌患者术前肠道准备方法的改进

目的 探讨肠内营养素和复方聚乙二醇电解质散口服应用于结、直肠癌患者术前肠道准备的效果.方法 将46例结、直肠癌择期手术患者随机分为观察组和对照组各23例.观察组于术前3 d开始口服整蛋白型肠内营养素,并于术前1 d 15:00后口服复方聚乙二醇电解质散行肠道准备.对照组术前3 d行传统的半流质、流质、禁食补液方法,于术前1 d 15:00后口服甘露醇进行肠道准备.观察并比较两组肠道准备期间不良反应发生情况,大便排空时间,肠道清洁度及肠道准备后的体重、血红蛋白、总蛋白、白蛋白及前白蛋白水平.结果 两组肠道清洁度及大便排空时间比较,差异无显著性意义(均P＞0.05).观察组不良反应发生率显著低于对照组(P＜0.05),肠道准备后的前白蛋白显著高于对照组(P＜0.05).结论 结、直肠癌患者实施改进后的术前肠道准备法可减少不良反应发生,同时改善患者营养状况.     

结直肠癌患者术前肠道准备方法的改进

目的探讨肠内营养素和复方聚乙二醇电解质散口服应用于结、直肠癌患者术前肠道准备的效果。方法将46例结、直肠癌择期手术患者随机分为观察组和对照组各23例。观察组于术前3d开始口服整蛋白型肠内营养素，并于术前1d15：00后口服复方聚乙二醇电解质散行肠道准备。对照组术前3d行传统的半流质、流质、禁食补液方法，于术前1d15：00后口服甘露醇进行肠道准备。观察并比较两组肠道准备期间不良反应发生情况，大便排空时间，肠道清洁度及肠道准备后的体重、血红蛋白、总蛋白、白蛋白及前白蛋白水平。结果两组肠道清洁度及大便排空时间比较，差异无显著性意义（均P〉0．05）。观察组不良反应发生率显著低于对照组（P〈0．05），肠道准备后的前白蛋白显著高于对照组（P〈0．05）。结论结、直肠癌患者实施改进后的术前肠道准备法可减少不良反应发生，同时改善患者营养状况。     

聚乙二醇电解质散溶液用于胃癌术前肠道清洁的临床观察

目的探讨胃癌患者术前肠道清洁的有效方法。方法将120例术前需肠道清洁的胃癌患者随机分为观察组和对照组各60例，观察组术前口服聚乙二醇电解质散溶液，对照组常规口服甘露醇溶液。结果观察组灌肠次数显著少于对照组（P〈0．01），肠道清洁获佳率显著高于对照组（P〈0．05），术后首次排气、排便时间显著早于对照组（均P〈0．01）。结论口服聚乙二醇电解质散溶液用于术前肠道清洁效果理想，且胃肠功能恢复快，无并发症发生。     

复方聚乙二醇电解质散联合乳果糖在结肠镜肠道准备中的应用观察

目的:比较复方聚乙二醇电解质散联合乳果糖、单纯复方聚乙二醇电解质散及硫酸镁在结肠镜肠道准备中的应用效果。方法:选取在我院脾胃科接受结肠镜检查的患者126例,随机分成3组,对照组、观察A组、观察B组,每组42例,对照组口服硫酸镁清肠,观察A组口服复方聚乙二醇电解质散清肠,观察B组口服复方聚乙二醇电解质联合乳果糖清肠,根据Boston肠道准备量表对肠道进行分段评分,计算肠道清洁率,并记录患者在肠道准备过程中不良反应的发生情况,比较3组的上述指标。结果:观察A组和观察B组肠道清洁有效率分别为92.85%、95.24%,明显优于对照组(80.95%),差异具有统计学意义(P<0.05)。但是观察B组在肠道清洁非常满意率明显优于观察A组,差异具有统计学意义(P<0.05)。观察A组和观察B组肠道不良反应发生率分别为9.52%、7.14%,明显低于对照组(16.66%),差异具有统计学意义(P<0.05)。观察B组比观察A组不良反应率有所下降,但比较无统计学差异(P>0.05)。结论:复方聚乙二醇电解质散联合乳果糖应用于结肠镜检查前的肠道准备,不仅能增加肠道清洁的有效率,还可以明显提高肠道清洁的质量,而且把不良反应少,安全性高,值得临床进一步推广。     

肠道准备方法对膀胱癌患者术后肠道清洁度和药物服用依从性的影响

目的 分析不同肠道准备方法对膀胱癌患者术后药物治疗的影响.方法 选择2013年10月至2014年11月来本院治疗膀胱癌的患者84例,随机分成对照组和研究组,各42例.两组均采用常规肠道准备方法,对照组同时服用蓖麻油后灌肠,研究组同时服用聚乙二醇电解质+蓖麻油后灌肠,观察两组肠道准备效果.结果 研究组肠道清洁情况明显优于对照组,不良反应发生率明显少于对照组,术后用药依从性明显高于对照组,差异均有统计学意义(P＜0.05).结论 对膀胱癌患者采用常规肠道准备方法加聚乙二醇电解质+蓖麻油后灌肠效果更明显,能有效地减少肠道准备时不良反应的发生率,提高肠道清洁度及术后用药的依从性,可作为膀胱癌患者术前肠道准备的首选方法.     

Bowel Cleansing Before Bowel Surgery: Major Discordance Between Evidence and Practice

Mechanical bowel cleansing (preparation) before colorectal surgery is commonly practiced, and medical care guidelines consent to this regimen. This has been an incontestable routine for surgeons for more than 100 years. However, during the last years, several randomized control trials and three meta-analyses led to the accumulation of enough evidence to conclude that no significant benefit is derived from this practice and thus, elective colorectal surgery can be safely done without mechanical bowel cleansing. Furthermore, several complications are attributed to mechanical bowel cleansing including anastomotic leakage, wound infections, and septic and non-septic complications that sometimes lead to the need for reoperation. Surgeons around the world may have to seriously reconsider the common practice of preoperative mechanical bowel cleansing. Despite the unquestionable practical value of mechanical bowel cleansing for bowel handling during anastomotic confection, we believe that current literature provides strong evidence that passed the line where this time-honored tradition may be finally called into question.     

Small bowel intussusception in adults

Intussusception is the telescoping of a proximal segment of the gastrointestinal tract into an adjacent distal segment. This rare form of bowel obstruction occurs infrequently in adults. We report a case of small bowel intussusception in an adult male patient. We have also performed a literature review of this rare condition.     

Bowel ischemia and gangrene—primary true enterolith

Enterolithiasis, or presence of stone concretions in the gastrointestinal tract, is an important but relatively uncommon clinical condition that has recently gained significant attention with advances in the gastrointestinal field.Here, we present a case of an old male having features of bowel Ischemia and gangrene formation. Patient underwent exploratory laparotomy and there was a presence of inflamed Gut with a perforation just one and half feet away from IC junction and an obstruction was also identified by following the dilated bowel loops distally, palpation revealed a hard stone and enterotomy incision at the site delivered a stone. Following it, resection of thickened mesentery was done and loop ileostomy was made.The most important prognostic factor in such cases relies on time interval between onset of symptoms and definitive treatment. By improving the awareness and early recognition of mesenteric ischemia will lead to improved survival in the condition.     

腹腔镜肠切除术：附30例病例报告

本文总结了美国哈佛大学医学院迪肯尼斯医院外科自１９９２年２月至１９９４年６月利用腹腔镜技术行肠切除３０例的结果，经验和体会。结论是该技术应用于肠肿瘤、肠炎症性疾病的肠切除是可行的。它有术后疼痛轻微，肠功能恢复快，住院时间短等优点。本文介绍了该手术的主要方法，并对手术的适应症，手术的优缺点，术后的护理以及手术的合并症进行了讨论。     

Motility and intraluminal pressure of the ileocolonic junctional zone and adjacent bowel in a canine model

Summary The exact role of the ileocecal valve (ICV) at the junction of small and large bowel is not well understood. Bowel segments used for the construction of urinary reservoirs incorporate the ICV. In the Indiana pouch its natural continence is used as one principle for achieving continence of the efferent limb. Motor activity and pressure in the ICV, the ileum and colon were registered in eight dogs. Myogenic activity of the bowel consisted of slow weves, irregular spontaneous contractions and superimposed spikes. Pressures of 7.2±0.3 cmH₂O were recorded in the ileum and of 5.6±0.4 cmH₂O in the colon. The pressure in the ICV was 12.7±0.4 cmH₂O rising to 26.4±2.2 cmH₂O during spontaneous depolarization. Balloon dilatation of the ileum resulted in relaxation of the ICV in 76% of experiments, whereas colonic distension was followed by a pressure increase in the ICV region in 80% of experiments. In 16% of cases a relaxation of the ICV area and a weaker response after repeated dilatation was noted. These findings make the ICV an unreliable continence mechanism as its long-term continence can not be predicted despite intraoperative evaluation. Additional measures to ensure consistent continence at the ICV (e.g. electric stimulation) need to be studied.     

Delayed bowel erosion by tension-free vaginal tape (TVT)

A 71-year-old woman who had had a previous abdominal hysterectomy and Burch operation presented with stress urinary incontinence due to intrinsic urethral sphincter deficiency. She underwent a technically difficult placement of a TVT tape in April 2002. After an uneventful recovery she was discharged after 72 hours but presented almost 5 months later with small bowel obstruction. At laparotomy she had a loop of ileum adherent to the left lower side wall of the pelvis, with the TVT tape penetrating and traversing this loop. The ileal segment was excised and an end-to-end anastomosis performed. Her recovery was uneventful and she is maintaining her urinary continence. Patients who have had previous combined pelvic intra- and extraperitoneal surgery should be operated on by experienced surgeons and be observed for 24 hours. The placement of a Uratape (Porges-Mentor) via a transobturator approach should also be considered in such cases. Abbreviations TVT tension-free vaginal tape     

Experimenteller Oesophagus-Totalersatz durch freie homologe und autologe Darmtransplantate

Zusammenfassung Es wurden in zwei Versuchsreihen an Hunden experimentelle Untersuchungen über den Totalersatz der Speiseröhre durch freie autologe Dickdarm- und homologe Dünndarmtransplantation durchgeführt. In beiden Versuchsreihen erfolgte die arterielle Anastomose direkt mit der Aorta thoracalis End-zu-Seit, die venöse mit der V. azygos End-zu-End. Nach Resektion der Speiseröhre im proximalen und distalen Drittel wurde eine Oesophago-Colostomie bzw. Oesophago-Jejunostomie durchgeführt. Entscheidend für die Durchblutung des Transplantats ist die Lumenweite der Arterie. In der ersten Versuchsreihe (autologe Dickdarmtransplantation), bei Verwendung der englumigen (2 bis 3 mm) A. mesenterica inferior, traten häufig arterielle Thrombosen auf, die zur Totalnekrose des Transplantats führten. In der zweiten Versuchsreihe (homologe Dünndarmtransplantation) erbrachte die Verwendung der relativ großlumigen (3 bis 5 mm) A. mesenterica superior einwandfreie, angiographisch verifizierte Durchblutungsverhältnisse des Dünndarmtransplantats. Nahtinsuffizienzen, arterielle bzw. venöse Thrombosen konnten nicht beobachtet werden. Obwohl wir über Spätergebnisse noch nicht verfügen, erscheint uns eine autologe Dünndaimtransplantation zum Totalersatz des Oesophagus beim Menschen, unter Anwendung der von uns beschriebenen Methode, möglich.

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Experimental total replacement of the esophagus by free homologous and autologous bowel transplantation

Summary Total replacement of the esophagus by free autologous large bowel and homologous small bowel transplantation was carried out in two series of experimental investigations in dogs. In both series the arterial anastomosis was completed directly with the thoracic aorta end to side, the venous anastomosis with the azygos vein end to end. After resection of the esophagus in the distal and proximal part and esophago-colostomy, or esophago-jejunostomy was performed. The diameter of the artery is of paramount importance for the circulation of the transplant. In the first series (autologous large bowel transplantation) wheie the tiny (2 to 3 mm ) inferior mesenteric artery was used, arterial thrombosis with consecutive total necrosis of the transplant was frequent.In the second series (homologous small bowel transplantation) the use of the comparatively large (3 to 5 mm ) superior mesenteric artery resulted in excellent vascularisation of the small bowel transplant which was verified by angiography. Suture line insufficienery arterial or venous thrombosis could not be observed. Although we cannot yet present late results, autologous small bowel transplantation for the total replacement of the esophagus in man should be possible applying this method.

Herrn Prof. Dr. A. Gütgemann zum 65. Geburtstag gewidmet.     

Colonic tumour precipitating caecal volvulus within a diaphragmatic hernia

An 85-year-old woman presented with sudden onset of generalised abdominal pain and absolute constipation for 4 d.On examination she had a distended abdomen.Plain abdominal radiograph revealed a gas filled viscous within the left upper quadrant.Subsequent computed tomography suggested caecal volvulus herniated through a left diaphragmatic hernia.The patient underwent reduction of the internal hernia,right hemicolectomy and mesh repair of the diaphragmatic hernia.Postoperative recovery was uneventful.Histology revealed a Dukes’A colonic cancer within the caecum.Herniation of caecal volvulus through a diaphragmatic hernia is a very rare condition and may have been precipitated by the colonic tumour.     

The second STEP: the feasibility of repeat serial transverse enteroplasty

Background

Serial transverse enteroplasty (STEP) lengthens and tapers dilated bowel. Redilation of the STEP segment occurs in some patients with intestinal failure. The feasibility of a repeat STEP procedure in a pig model is evaluated.

Methods

Six pigs underwent reversal of an intestinal segment distal to the ligament of Treitz. At 6-week intervals after reversal, each animal had 2 STEP procedures on the bowel proximal to the reversed segment. Necropsy was performed up to 6 weeks after repeat STEP.

Results

Bowel length increased by 11.3 ± 3.9 cm and bowel diameter decreased from a mean of 5.3 ± 0.8 to 1.8 ± 0.4 cm (P < .0001) after the first STEP. After repeat STEP, bowel length increased by 16.7 ± 13.3 cm (P < .01), and the bowel was tapered from a mean of 5.4 ± 0.9 to 2.2 ± 0.4 cm (P < .01). Five pigs did well after repeat STEP, and 1 pig had early necropsy for bowel obstruction. None had histologic evidence of bowel ischemia in the repeat STEP segment.

Conclusions

A second STEP operation is feasible in a pig model and may be considered to optimize bowel length and function in select patients with intestinal failure.     

老年癌性结直肠梗阻诊治体会--附58例临床分析

目的　探讨老年癌性结、直肠梗阻的诊治方法。方法　分析５８ 例老年癌性完全性结、直肠梗阻的临床表现,腹部Ｘ线检查、Ｂ超、ＣＴ、钡灌肠和腹腔穿刺等检查, 以及血清肌酸磷酸激酶和血清乳酸脱氢酶的测定, 对老年癌性结、直肠梗阻可能出现的绞窄性肠梗阻作出早期诊断,全面评估老年患者各脏器功能后,早期手术治疗。结果　本组５８ 例患者中有５５ 例行手术治疗。从入院至手术时间３ 小时至５ 天。术中诊断１３ 例为绞窄性肠梗阻,其中５ 例术前做出诊断,符合率３８％ 。５５ 例手术患者术后发生并发症３４ 例,死亡５ 例,病死率９ ％ ,其中绞窄性肠梗阻死亡３ 例。结论　对于老年癌性结、直肠梗阻, 能够早期并准确地认识到绞窄性肠梗阻的发生,对治疗和预后具有重要意义。