经肛减压导管置入处理结直肠癌并急性梗阻的临床观察

目的 探讨内镜辅助下经肛门置入减压导管在低位结直肠癌并急性肠梗阻中的应用及疗效观察。方法 13例急性结直肠癌性梗阻患者在结肠镜辅助下,经肛门置入肠梗阻减压导,灌洗、引流等保守治疗7~10天后行一期根治手术。结果 13例患者均成功置入减压导管;术后患者腹痛、腹胀明显缓解,腹胀呕吐症状消失;置管后第3天,腹围由92.7±5.7 cm减小到81.2±4.8 cm;腹腔内压力由21.00±1.5 cmH₂O减至12.2±0.8 cmH₂O;减压导管引流量从782.3±72.1 mL下降至33.8±15.3 mL;梗阻近端肠管最大横径由5.4±0.6 cm缩小至2±0.3 cm（均P<0.001）。所有患者均接受一期结肠癌根治手术,术后未发生吻合口漏、伤口、腹腔感染等并发症。结论 对于低位结直肠癌伴发急性肠梗阻,经肛门置管减压不仅可显著缓解梗阻症状同时有利于改善患者全身状况并进行充分的术前准备,为一期根治性手术赢得时机;具有有效、安全、经济、创伤小等优势。     

经肛型肠梗阻导管在结直肠恶性梗阻中的应用

目的：探讨经肛型肠梗阻减压导管在结直肠恶性梗阻治疗中的应用价值。方法：应用经肛型肠梗阻导管对30例结肠癌伴肠梗阻患者行导管置入术,冲洗引流4～10 d后手术。结果：28例成功置入导管,成功率93.3%;2例因导丝无法通过狭窄部位,而转行急诊手术。成功的28例患者导管减压引流时间为4～10 d,平均（5.8±1.6）d。置入导管后（3.8±1.3）d患者腹痛、腹胀症状明显减轻。与入院时腹围（92.1±7.4）cm相比,手术时腹围缩小至（83.9±5.8）cm（P=0.013）。减压后96.4%（27/28）的患者行一期切除吻合,术后无吻合口瘘发生。结论：经肛型肠梗阻减压导管治疗结直肠恶性梗阻是安全、有效的,可作为治疗结直肠恶性梗阻的首选措施。     

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。     

肠梗阻导管减压联合肠内营养在结直肠癌性梗阻治疗中的应用研究

目的评价经肛肠梗阻导管减压联合肠内营养在急性结直肠癌性梗阻治疗中的应用价值。方法 47例急性完全性梗阻性结直肠癌患者经肛门置入肠梗阻导管,42例成功置入导管,减压成功后给予肠内营养,肠内营养6～7d后手术。检测入院时、术晨的血清白蛋白、前白蛋白、转铁蛋水平。结果 42例患者术晨的血清前白蛋白,血清白蛋白和转铁蛋白水平,与入院时比较均有明显提高(P<0.05,P<0.01)。全部患者成功行结直肠癌Ⅰ期根治切除吻合术,术后恢复顺利,未发生严重并发症。结论经肛门置入肠梗阻导管减压联合肠内营养可以改善结直肠癌并发肠梗阻患者的术前营养状况,安全可行。     

肠梗阻导管在结直肠癌性肠梗阻治疗中的应用研究

目的 探讨肠梗阻导管治疗结直肠癌性肠梗阻的临床效果.方法 对我院2005年12月至2008年12月期间收治的32例结直肠癌性肠梗阻患者先行经鼻和经肛两种途径置入肠梗阻导管,通过导管减压、引流等治疗后,再行一期根治切除吻合术.结果 32例患者中19例经鼻及经肛型肠梗阻导管双侧同时性置入成功,另13例仅完成经鼻型肠梗阻导管置入.置管12～36 h后所有患者腹痛、腹胀症状明显缓解;26例于48～96 h后腹痛、腹胀症状完全消失.比较所有患者置管前、后腹围缩小程度,置管24 h后为(81.3±19.6)%,明显小于置管前的100%(t=3.586,P=0.02).32例患者经肠梗阻导管治疗5～7 d后,均成功施行一期根治切除吻合术,术后无腹腔感染、吻合口漏等严重并发症发生.结论 经肠梗阻导管减压、引流等治疗后再行一期根治切除吻合术,是治疗结直肠癌性肠梗阻的有效方法.     

经肛门肠梗阻导管在结直肠癌性梗阻治疗中的应用

目的探讨肠梗阻导管治疗急性结直肠癌性梗阻的可行性与临床疗效。俩方法在X线辅助下,经内镜放置肠梗阻导管治疗21例急性结直肠癌性梗阻的患者。结果 19例放置肠梗阻导管成功,成功率为90.5%,19例术后1~2 d梗阻症状缓解或消除,13例经内镜治疗解除梗阻后5~7 d行I期肿瘤切除吻合术,术后均恢复顺利,无感染及吻合口漏等并发症发生。2例因病变部位过度狭窄导管无法通过而治疗失败,2例术后1~3 d导管滑脱再次置管。结论肠梗阻导管治疗急性结直肠癌性梗阻,能够有效缓解患者的梗阻症状,显著降低患者的创伤和痛苦,增加手术安全性,提高患者的生活质量。     

经肛肠梗阻导管联合腹腔镜手术治疗结直肠恶性梗阻

目的 评价经肛肠梗阻减压导管联合腹腔镜手术在结直肠恶性梗阻治疗中的应用价值.方法 2007年3月至2010年10月37例急性完全性结直肠恶性梗阻患者经肛置入肠梗阻导管至梗阻近端肠管,冲洗引流4～10 d后行腹腔镜探查并一期切除吻合.结果 37例患者中34例成功置入导管,导管引流时间为4～10 d,平均(5.8±1.6)d.置入肠梗阻导管后(3.8±1.3)d(1～7 d)患者腹痛、腹胀症状消失.与入院时腹围(92 4±7)cm相比,手术时腹围(84±6)cm,明显缩小(P=0.013).其中31例患者减压后完成腹腔镜一期根治切除吻合,术后患者恢复顺利,无严重并发症.结论 经肛型肠梗阻减压导管联合腹腔镜手术治疗急性结直肠梗阻安全、有效,可将急诊手术转为限期手术,在适当的肠道准备后腹腔镜下根治手术并一期吻合是可行的.

Abstract：

Objective To evaluate the safety and efficacy of transanal drainage tube followed by laparoscopic surgery in management of malignant colorectal obstruction. Methods From March 2007 to October 2010, 37 patients with colorectal cancer manifesting acute complete mechanical obstruction were treated by ileus tube drainage. After irrigation and drainage ranging from 4 to 10 days, the radical operations and anastomosis were performed by laparoscopy. Results The drainage tubes were successfully implanted in 34 patients. The decompression time of patients was (5. 8 ±1.6) d, ranging from 4 to 10 d. The abdominal pain and bloating symptoms were faded away after (3. 8 ±1.3) d (1 to 7 d) drainage. And comparing to that of patients when admission, abdominal circumference significantly reduced from ( 92 ± 7 ) cm to (84 ±6)cm(P =0. 013) before surgery. Thirty-one cases were performed radical resection and anastomosis by laparoscopy after decompression. Postoperative recovery was smooth, and there was no serious complication. Conclusions Laparoscopic surgery followed decompression by transanal ileus tube is effective and safe for acute lower colorectal obstruction. Emergency surgery may be converted to limit surgery by this method. After appropriate bowel preparation, laparoscopic radical surgery and anastomosis is feasible.     

经肛型肠梗阻减压导管在急性低位结直肠梗阻中的应用

目的初步评价经肛型肠梗阻减压导管在急性低位结直肠梗阻中的应用。方法2004年11月至2005年12月,对15例急性完全性机械性低位结直肠梗阻患者行肠梗阻导管置入术,冲洗引流7 d后手术。结果13例成功,患者术前腹围(91±4)cm,7 d后缩小到(82±2)cm；导管内每天引流量减冲洗量为-600～3200 ml；术后7 d腹部平片显示肠管扩张较术前明显好转,气液平面减少。手术中发现肠壁水肿不明显,增加了局部切除的可能。有2例治疗失败,其中1例系导丝无法通过狭窄部,另1例是肿块位于横结肠中部。结论肠梗阻减压导管治疗急性低位结直肠梗阻初步显示有效而安全。     

脾曲远端结直肠癌合并肠梗阻经肛肠梗阻导管置入治疗47例分析

目的探讨经肛肠梗阻导管置入治疗脾曲远端结直肠癌合并肠梗阻的可行性,同时评价其安全性。方法回顾性分析2009年7月至2013年6月收治的脾曲远端结直肠癌合并肠梗阻患者93例,其中传统手术治疗组46例,肛肠梗阻导管置入组47例,采用统计学软件SPSS 16.0对记录的临床数据进行分析,计量资料采用t检验,用(x珋±s)表示;计数资料采用χ2检验,P0.05表示差异具有统计学意义。结果肛肠梗阻导管置入组患者的腹围周长、腹内压、梗阻近端肠管的最大横径明显减小,胃管、导管引流量明显减少,与置管前比较差异显著,均具有统计学意义(P均0.05);肛肠梗阻导管置入组腹部症状的缓解率达到93.62%且明显高于传统手术治疗组(10.87%);肛肠梗阻导管置入组并发症发生率、总住院时间、总住院费用也明显低于传统手术治疗组(P均0.05)。结论经肛肠梗阻导管置入治疗脾曲远端结直肠癌合并肠梗阻,取得十分显著的临床疗效,提高患者的存活率和康复率,安全有效,应在临床上大力推广使用。     

经肛肠梗阻导管在结肠癌性肠梗阻治疗中的应用效果及护理措施

目的：探讨经肛肠梗阻导管在结肠癌性肠梗阻治疗中的应用效果,并总结护理措施。方法：选择2019年1月至2020年9月于我院肠胃外科就诊的50例结肠癌性肠梗阻患者为研究对象,患者均经肛置入肠梗阻导管治疗,并且置管前接受胃肠减压及心理护理,置管后接受导管安全管理、冲洗护理、饮食指导、会阴皮肤护理等。统计患者置管后肠梗阻缓解时间、置管前后相关临床指标的变化,以及手术情况。结果：患者均成功经肛放置肠梗阻导管,置管后24～48h症状缓解28例,48～72h症状缓解21例,72h以后缓解1例。置管后第3天患者腰围、腹内压、近端肠管最大横径、减压导管引流量均明显小于置管前,P <0.05或P <0.001。本组48例患者接受Ⅰ期根治性手术,2例患者因肿瘤转移接受姑息性手术并永久性造口。结论：经肛肠梗阻导管用于结肠癌性肠梗阻治疗安全有效,可快速解除梗阻症状,为Ⅰ期手术创造条件。     

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??Clinical therapeutic effect of trans-anal ileus tube placement in acute obstruction result from left colorectal cancer LIU Qi , SU Ji, LUO Wei-zhen, et al. Department of General Surgery, the People’s Hospital of Hunan Province, Changsha 410005, China
Corresponding author: HUANG Zhong-cheng, E-mail: drliuqi@126. com
Abstract Objective To evaluate the clinical therapeutic effect of trans-anal ileus tube placement and drainage in acute obstruction result from left colorectal cancer. Method From Dec. 2007 to Jun. 2009, 29 patients of acute obstruction result from left colorectal cancer were admitted in the People’s Hospital of Hunan Province. 15 patients were received trans-anal ileus tube placement and drainage for 10 to 20 days before limited operation; and the other 14 patients were received emergency operation. The clinical effect, modus operandi, recovery effect, length of stay in hospital and the cost of hospitalization were observed in the two group patients. Result 15 patients were placed the trans-anal ileus tube successfully. Besides 1 patient’s tube prolapsed negligently after three days, the others rechecked the abdomen X-rays and founded the bowel obstructive signs disappeared before radical excision without abdominal stoma. The other 14 patients who received emergency operation needed further surgery treatment. Two group patients had no severer complications and the tube placement group had shorter length of total stay in hospital???25.90±2.46??d vs ??29.70±1.52??d??P<0.05??and the lower cost of hospitalization???27500.00±2163.5342????vs ??33200.00± 2512.4267??????P<0.05??. Conclusion Trans-anal ileus tube placement and drainage in acute obstruction result from left colorectal cancer could successfully avoid patients received surgical attack again. It was effective and safe and may be the first choice of clinical therapeutic.     

生长抑素联合经肛肠梗阻导管在远端结肠恶性肠梗阻老年病人中的应用

目的评价生长抑素联合经肛肠梗阻减压导管在远端结肠恶性肠梗阻治疗中的应用价值。方法回顾分析2010年9月至2016年11月经手术治疗的57例急性完全性远端结肠恶性梗阻老年病人(年龄均≥70岁),2013年以来济宁市第一人民医院采用经肛肠梗阻导管治疗部分肠梗阻病人,31例经生长抑素持续静脉泵入及经肛置入肠梗阻导管综合治疗4~10 d,平均(5.6±1.2)d,后行腹腔镜或剖腹探查;26例经生长抑素持续静脉泵入治疗后行手术治疗。结果 31例经生长抑素及经肛置入肠梗阻导管综合治疗的病人术前腹痛及腹胀症状均得以缓解;与入院时腹围(100%)相比,术前腹围明显缩小,为(81±2.3)%(P=0.001);综合治疗后3 d行腹部CT检查,测量近端结肠最大横径为(2.8±0.3)cm,明显小于治疗前的(6.2±0.5)cm(P=0.001);31例病人均行手术治疗,其中18例病人行腹腔镜探查手术,11例完成根治手术并行一期吻合(腹腔镜下完成7例),20例行肿瘤切除并近端结肠造口术,术后病人均无严重并发症。26例经生长抑素持续静脉泵入治疗病人中,仅5例行一期吻合,无一例在腹腔镜下完成,术后1例出现肠瘘并发症。结论生长抑素联合经肛肠梗阻导管治疗对急性远端大肠恶性肠梗阻的老年病人安全有效,有较高的腹腔镜手术完成率及一期吻合成功率,降低了围手术期风险,避免了二次手术,减轻了病人的经济负担。     

Endoscopic decompression using a transanal drainage tube for acute obstruction of the rectum and left colon as a bridge to curative surgery

Objective  The aim of this study was to clarify the usefulness of the management of acute left colon and rectum obstruction because of colorectal carcinoma using a transanal ileus drainage tube before curative surgery.
Method  Forty-six patients (24 males and 22 females, aged 24–94 years, mean = 56.2) treated between September 2005 and March 2007 for acute left colon and rectal obstruction were identified in a colorectal obstruction database, and their clinical and radiological features were reviewed. After a cleaning enema was administered, urgent colonoscopy was performed. Subsequently, endoscopic decompression using a ileus tube was attempted.
Results  Endoscopic decompression using the ileus tube was technically successful in 45 of 46 patients (97.8%). Perforation occurred in one patient 3 days later and emergent operation was performed. The site of obstruction was the rectum in 15 patients, the sigmoid colon in 18, the descending colon in 13. Following adequate cleansing of the colon, patients' abdominal girth were decreased from 91 ± 4 cm before drainage to 82 ± 2 cm 7 days later, and one-stage surgery after 8 ± 1 days (SD; range 7–10 days) were performed. No anastomotic leakage or postoperative stenosis occurred after operation.
Conclusion  Management of acute left colon and rectum obstruction because of colorectal carcinoma using the ileus tube was found to be effective and safe, considered as a bridged method before curative surgery.     

生长抑素联合肠梗阻导管治疗粘连性肠梗阻

目的 探讨生长抑素联合肠梗阻导管在粘连性肠梗阻非手术治疗中的应用价值.方法 将91例粘连性肠梗阻患者按入院顺序随机分为A组(生长抑素+肠梗阻导管组),B组(生长抑素+鼻胃管减压组),C组(肠梗阻导管组)和D组(鼻胃管组).常规治疗包括禁食、纠正水电解质和酸碱平衡紊乱,全胃肠外营养以及应用抗生素.A组在常规治疗基础上应用生长抑素类似物(善宁)0.6 mg加入0.9％氯化钠溶液500 ml持续静脉滴注,同时联合置入肠梗阻导管取代普通鼻胃管行肠内减压.观察和比较4组治疗前后临床症状及体征改善情况、胃肠减压量、自主排气、排便时间和中转手术率.数据分别采用方差分析和x2检验进行分析.结果 各组平均腹痛和腹胀的缓解时间分别为3.6±1.5,5.3±1.8,5.8±1.7和8.4±2.2d (F=28.715,P=0.000);恢复排气、排便时间分别为4.5±1.9,5.7±1.4,6.0±1.1和7.8±1.7 d(F=23.857,P=0.000);A组临床症状明显改善.平均胃肠减压量分别为A组:632±102 ml/d;B组:410±86 ml/d,C组:1020±148 ml/d和D组590±97 ml/d.在C组,患者的胃肠减压量明显增加(F值分别为17.367,16.347,P=0.000),而A组则明显减少(F值分别为11.687,10.399,P=0.000).4组中转手术率分别为0(0/22),10％ (2/19),9％( 3/23)和22％ (6/27),A组中转手术率明显低于D组(x2=5.571,P=0.018).结论在常规治疗的基础上,应用生长抑素静脉持续泵入联合肠梗阻导管治疗,可加速改善粘连性肠梗阻患者的临床症状,并且提高保守治疗的成功率.     

结肠镜联合腹腔镜治疗左半结肠癌梗阻的临床研究

目的 评价结肠镜辅助下术前经肛门置管减压,以及在腹腔镜下左半结肠癌一期切除、吻合的疗效,探讨左半结肠癌伴肠梗阻的治疗选择.方法 2004年12月至2007年8月治疗11例左半结肠癌伴肠梗阻:(1)在结肠镜辅助和x线指引下经肛门将肠梗阻导管置入梗阻部位的近端肠管进行减压,观察患者症状缓解情况、肠鸣音、腹围、腹腔内压力、腹平片等的变化,评价肠梗阻的治疗效果;(2)肠梗阻缓解后,经常规术前准备后行择期腹腔镜左半结肠癌一期切除、吻合.结果 (1)置管减压5～14 d后,11例患者的肠梗阻症状均有缓解,避免了急诊手术;(2)11例患者均接受腹腔镜下一期切除、吻合手术;(3)11例患者均未出现吻合口漏、切口感染、腹腔内感染等手术并发症;(4)平均随访15.2个月:局部复发率为9%(1/11),切口或穿刺孔种植率为0(0/11),无瘤生存率为91%(10/11).结论 结肠镜辅助术前减压,联合腹腔镜一期切除吻合治疗左半结肠癌肠梗阻安全有效,此法可能成为治疗左半结肠癌的最合理的治疗策略.