不同剂量奥曲肽治疗手术后粘连性肠梗阻的疗效比较

目的探讨不同剂量奥曲肽对术后粘连性肠梗阻的疗效。方法将90例术后粘连性肠梗阻（非绞窄性）患者分为奥曲肽常规剂量组（基础治疗加奥曲肽0．1mg皮下注射,1／8h）、加倍剂量组（基础治疗加奥曲肽0．1mg皮下注射,1／4h）和对照组（基础治疗）。比较3组患者治疗7d后的临床症状、胃肠减压量及实验室指标的变化。结果奥曲肽加倍剂量组在缩短腹痛时间、减少胃肠减压量、降低谷丙转氨酶和总胆红素及空腹血糖水平方面均显著优于常规剂量组和对照组（P〈0．05）．但总有效率与常规剂量组差异无统计学意义（P〉0．05）。结论加倍剂量奥曲肽治疗手术后粘连性肠梗阻疗效佳。     

奥曲肽治疗粘连性肠梗阻疗效观察

目的 探讨奥曲肽（善得定）治疗粘连性肠梗阻的疗效。方法 60例肠梗阻患者随机分为奥曲肽组（31例）和对照组（29例），两组间年龄、性别及肠梗阻的病因比较差异无显著性。奥曲肽组25例采用奥曲肽0．1mg，皮下注射，每6h或8h1次，连用3．6天，同时按常规治疗禁食、胃肠减压、补液及纠正水电解质酸碱平衡；23例对照组则按常规治疗禁食、胃肠减压、补液及纠正水电解质酸碱平衡。结果 治疗组胃肠减压量在用药后即明显减少，肛I门排气时间明显提前，临床症状在2天内消失占75％，住院时间平均缩短5天，差异均有显著性。结论 奥曲肽辅助治疗粘连性肠梗阻能抑制肠管内体液丧失，缓解扩张，促进蠕动，解除梗阻，对粘连性和术后炎性肠梗阻有明显作用。     

奥曲肽治疗粘连性肠梗阻疗效研究

目的笔者对应用奥曲肽对粘连性肠梗阻的疗效进行了观察研究。方法将粘连性肠梗阻患者60例随机分为奥曲肽组（33例）和对照组（27例）,两组间年龄、性别及肠梗阻的病因比较差异无显著性。奥曲肽组采用奥曲肽0.1mg,皮下注射,每6小时或8小时1次,连用3～6天,同时按常规治疗予禁食、胃肠减压、补液等对症治疗;对照组则按常规治疗予禁食、胃肠减压、补液及纠正水电解质酸碱平衡。结果用药后治疗组胃肠减压量明显减少,肛门排气时间明显提前,临床症状在2天内消失占65%,住院时间平均缩短3天,差异均有显著性。结论奥曲肽辅助治疗粘连性肠梗阻能抑制肠管内体液丧失,缓解扩张,促进蠕动,对粘连性肠梗阻有明显作用。     

鼻肠管减压及奥曲肽治疗术后早期炎症性肠梗阻的临床研究

目的 评价、比较鼻肠减压导管以及奥曲肽,在腹部手术后早期炎症性肠梗阻保守治疗中的作用.方法 2005年3月至2009年1月期间45例腹部手术后早期炎症性肠梗阻的患者,使用鼻胃管减压等常规保守治疗无效后,非随机分为肠减压导管治疗组(23例)以及奥曲肽治疗组(22例),比较两种治疗方法与常规保守治疗方法以及两种治疗方法之间的疗效差别.结果 经鼻胃管减压的常规保守治疗无效的45例患者,经过上述两种治疗方法的保守治疗,3-12 d所有患者的肠梗阻均得以缓解;与奥曲肽治疗组相比,肠减压导管治疗组的自主排气时间更短[(4.7±1.9)d比(6.7 ±1.6)d]、腹围恢复得更快[(90.4±2.0)%比(95.1±1.3)%],但累计胃肠减压量[(4037±1155)ml比(3316±1038)m1]及日均胃肠减压量[(890±181)ml比(492±83)ml均更多,两组差异均有统计学意义(P均＜0.05).结论 肠减压导管以及奥曲肽治疗术后早期炎症性肠梗阻安全有效,肠减压导管的治疗时间更短,奥曲肽能够降低胃肠减压量.     

奥曲肽在胃肠道肿瘤所致恶性肠梗阻治疗中的应用

目的探讨生长抑素类似物——奥曲肽治疗胃肠道肿瘤所致恶性肠梗阻的临床效果。方法回顾性分析2006年1月～2008年2月我院42例恶性肠梗阻的临床资料,分为奥曲肽组23例和对照组19例,比较2组患者在治疗后腹痛、腹胀症状变化,肛门恢复排气排便时间,胃肠减压量,中转手术率和住院时间。结果奥曲肽组腹胀、腹痛缓解率78.3%（18/23）较常规组36.8%（7/19）有明显改善（χ2=7.409,P=0.006）;奥曲肽组胃肠引流量（409.1±32.4）ml显著少于常规组（605.7±45.9）ml（t=-16.237,P=0.000）;奥曲肽组中转手术率21.7%（5/23）显著低于常规组63.2%（12/19）（χ2=7.409,P=0.006）;治疗后肛门开始排气时间奥曲肽组（4.1±1.3）d显著短于常规组（6.5±2.7）d（t=3.773,P=0.000）;治疗后奥曲肽组生活质量明显改善,KPS评分为（61.2±7.2）分,显著高于常规组（45.1±7.8）分（t=4.910,P=0.000）。结论在常规治疗基础上加用生长抑素类似物奥曲肽能改善胃肠道肿瘤所致肠梗阻患者的临床症状,降低中转手术率,改善患者生活质量。     

生长抑素在肠梗阻治疗中的临床应用

目的探讨生长抑素类似物——奥曲肽治疗肠梗阻的临床效果。方法回顾性分析120例肠梗阻患者治疗的临床资料。结果与常规保守治疗组相比．加用奥曲肽治疗组临床症状改善明显，胃肠引流量减少．肛门排气时间缩短，治愈率提高，住院时间缩短（均P〈0．01）;然而，两组中转手术率的差异无统计学意义（P〉0．05）．结论在常规治疗基础上加用奥曲肽．能明显改善肠梗阻患者临床症状．提高治疗成功率。     

自体骨髓细胞经门静脉移植治疗肝硬化与肝功能不全的临床研究

目的观察自体骨髓细胞经门静脉移植对肝硬化和肝功能不全的治疗效果。方法2005年2月至2006年6月在我科接受手术治疗的40例肝硬化门静脉高压症患者（脾切除、断流术或内镜食道曲张静脉套扎术）,被随机分为治疗组和对照组,每组20例。两组患者于术中埋置“门静脉导管-皮下药盒”,术后3-4周,治疗组经移植通道输注自体骨髓细胞,而对照组只输注生理盐水。在第1次输注后每隔1个月再重复进行输注,共输注3次。第3次输注后1个月进行疗效评价。结果（1）两组恢复均顺利,未发现与移植操作有关的不良反应或并发症。（2）丙氨酸转氨酶、总胆红素、白蛋白和凝血酶原时间：治疗组分别由（60±52）μmol／L、（26±15）μmol／L、（33±5）μmol／L和（18±2）s变为（26±15）μmol／L、（14±8）μmol／L、（41±3）μmol／L和（12±2）s（P〈0．01）;对照组分别由（47±37）μmol／L、（22±23）μmol／L、（35±4）μmol／L和（18±4）s变为（65±51）μmol／L、（19±42）μmol／L、（35±4）μmol／L和（18±4）s（P〉0．05）;治疗组优于对照组（P〈0．01）。（3）血清透明质酸和前胶原Ⅲ肽：治疗组分别由（188±160）ng／ml和（13±18）ng／ml变为（104±80）ng／ml和（8±9） ng／ml（P〈0．05）;对照组分别由（79±193）ng／ml和（10±16）ng／ml变为（136±187）ng／ml和（9±17）ng／ml（P〉0．05）;治疗组亦优于对照组（P〈0．01）。结论自体骨髓细胞经门静脉移植可改善肝功能和肝纤维化血清学指标。     

奥曲肽联合FOLFOX化疗方案治疗恶性肠梗阻

目的观察奥曲肽联合FOLFOX化疗方案治疗晚期结直肠癌合并肠梗阻的近期疗效和不良反应。方法本组30例恶性肠梗阻患者中．初治病例13例．复治病例（以往接受过化疗）17例。均接受2-4个周期联合治疗：奥曲肽0．6mg／d,持续静脉注射;氟尿嘧啶（5-FU）2000mg／m2,静脉滴注,持续48h;草酸铂85mg／m2,静脉滴注d1;甲酰四氢叶酸钙（CF）200mg／m2,d1和d2,静脉滴注;每14d为1周期。评价治疗后化疗有效率、肠梗阻治疗有效率及不良反应。结果本组患者化疗有效率为40．0％（12／30）,其中初治组为53．9％（7／13）,复治组为29．4％（5／17）,差异无统计学意义（P=0．264）。肠梗阻治疗有效率为50．0％（15／30）,其中初治组有效率为69．2％（9／13）,复治组为35．3％（6／17）。差异无统计学意义（P=0．139）。除1例患者出现Ⅲ度白细胞减少．1例出现Ⅲ度恶心呕吐外．其余患者不良反应程度均较轻（0～Ⅱ度）。结论奥曲肽联合FOLFOX化疗对于治疗晚期结直肠癌合并肠梗阻有较为满意的近期疗效。     

生长抑素联合口服万古霉素治疗肝移植术后早期肠梗阻

目的探讨生长抑素联合口服万古霉素治疗肝移植术后早期肠梗阻的疗效。方法将2005年1月至2006年12月间收治的肝移植术后早期发生肠梗阻的58例患者，根据时间和治疗方法分成A组（2005年1月至2005年12月，31例，给予包括禁食、胃肠减压、纠正水电解质和酸碱平衡紊乱，适当胃肠内、外营养以及应用抗生素的常规治疗）和B组（2006年1月至2006年12月，27例，同A组常规治疗措施外，配合采用生长抑素及口服万古霉素）。结果本组肝移植术后早期术后肠梗阻发生率为13％（58／441）。B组患者恢复肠鸣音及排气、排便的时间分别为（7．1±2．0）d和（8．4±2．4）d，A组则分别为（9．1±3．0）d和（10．8±3．4）d；两组差异有统计学意义（P〈0．05）。B组胃肠减压引流量[（298±58）ml／d]明显比A组[（485±106）ml／d]减少；B组发生菌群失调的比例（55％）比A组（77％）明显降低；两组差异亦均有统计学意义（均P〈0．05）。结论在常规治疗基础上，应用生长抑素联合口服万古霉素治疗肝移植术后早期肠梗阻，可明显改善临床症状，减少肠道菌群失调的发生率。     

全反式维甲酸和三氧化二砷协同诱导胰腺癌细胞凋亡

目的研究与三氧化二砷（As2O2）具有协同效应治疗胰腺癌的药物。方法以胰腺癌细胞系SWl990为研究对象，观察5-氟尿嘧啶（5-Fu）、健择（Gemcitabine）和全反式维甲酸（AT—RA）与As2O3共同作用对细胞的影响。通过台盼蓝拒染法检测细胞生长和细胞活力，流式细胞仪检测AnnexinV或PI阳性细胞的含量，评价以上药物对细胞增殖和凋亡的作用。结果5-Fu和Gemcitabine与As2O3无协同效应。单独应用As2O3或ATRA均抑制SWl990细胞生长，不诱导细胞凋亡。其中，对照组活细胞密度为（8．5±0．3）×10^5个／ml，As2O3组为（4．4±0．1）×10^5个／ml，ATRA组为（6．7±0．2）×10^5个／ml。但是，As203和ATRA共同处理SWl990细胞后，细胞生长明显抑制，并诱导细胞凋亡。对照组活细胞密度为（8．5±0．3）×10^5个／ml，As2O3＋ATRA组为（3．3±0．1）×10^5个／ml；对照组细胞活力为（92，0±1．2）％，As2O3组为（90．0±1．3）％，ATRA组为（93．0±1．4）％，As2O3＋ATRA组为（65．0±2．1）％；对照组Annexin V和PI阳性细胞的含量为（6．0±1．2）％，As2O3组为（11．0±3．3）％，ATRA组为（5．0±1．4）％，As2O3＋ATRA组为（37．0±5．3）％。结论As2O3和ATRA可协同诱导胰腺癌细胞凋亡，两者联合应用可能作为胰腺癌辅助治疗的另一选择。     

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.     

Clinical outcomes of manual bowel decompression (milking) in the mechanical small bowel obstruction: a prospective randomized clinical trial

BackgroundThe aim of this prospective randomized study was to investigate the effects of manual bowel decompression in patients who were operated on for mechanical small bowel obstruction.MethodsBetween March 2008 and February 2010, 40 consecutive patients with mechanical small bowel obstruction were randomized into 2 clinically comparable groups. The intestinal content of the dilated small bowel was caressed to the stomach (by milking) and aspirated via a nasogastric tube in the milking group (group M, n = 20) and left uncaressed in the control Group (group C, n = 20). Patients' characteristics and general operative outcomes were compared and analyzed.ResultsThe resumption of a regular diet and postoperative hospital stay (P = .68) were not significantly different in groups M and group C. Similarly, there were no differences between the 2 groups regarding respiratory complications (P = .34), bacterial translocation (P = 1), or wound infection (P = 1).ConclusionsThe findings suggest that routine milking is unnecessary in mechanical small bowel obstruction.     

奥曲肽治疗晚期卵巢癌所致肠梗阻的疗效观察

目的 研究奥曲肽治疗晚期卵巢所致肠梗阻的作用. 方法 将通过临床症状和腹部X线平片及PET/CT明确诊断为晚期卵巢癌所致肠梗阻非手术治疗患者64例分为两组:对照组(n=34)常规治疗,即禁食、鼻胃管胃肠减压、灌肠、全肠外营养(total parenteral nutrition,TPN)支持;治疗组(n=30)除常规治疗外,使用奥曲肽治疗,剂量为0.6 mg/d,持续静脉泵入.观察两组治疗开始前1d、治疗第4和第7d的鼻胃管引流量.当症状缓解、排气、鼻胃管引流量≤100 ml/d时,拔除鼻胃管,同时观察两组的鼻胃管拔除率. 结果 两组患者经治疗后病情均出现明显缓解.两组患者经治疗后病情均出现明显缓解.与对照组相比,治疗组治疗第4d胃液引流量显著减少,为(573.6 ±312.1)ml/dvs.(1 003.9±275.2) ml/d(P＜0.001),治疗第7d进一步减少,为(78.4±116.2) ml/d vs.(487.3±103.5) ml/d (P＜0.001).治疗组患者鼻胃管拔除率显著提高(83.3％vs.20.6％,P＜0.001).结论 奥曲肽可显著减少胃液的引流量,使大部分患者摆脱胃肠减压和TPN,在晚期癌性肠梗阻患者非手术治疗中具有重要作用.     

Comparison of Mechanical Bowel Obstruction Cases of Intra-abdominal Tumor and Non-tumoral Origin

Introduction Mechanical bowel obstruction cases constitute an important place in emergency health care services. In this study, bowel obstructions caused by intra-abdominal tumors were compared with those without tumoral causes. Patients and Methods A total of 155 cases of mechanical bowel obstruction diagnosed were retrospectively evaluated. The cases resulting from abdominal wall hernias were excluded. Neoplasia cases were classified as group I, and all other cases as group II. Results Group I totaled 46 patients (30%); group II, 109 (70%). The difference between two groups in terms of gender was found to be statistically insignificant, but the difference in terms of age range was significant (P < 0.05). The etiology of group II cases included intra-abdominal strictures (n = 68), volvulus (n = 15), internal herniation (n = 7), Meckel’s diverticulum (n = 7), tuberculous peritonitis (n = 4), foreign body (n = 4), invagination (n = 2), and inflammatory bowel disease (n = 2). Previous surgical operations had been performed in 9 patients (19%) of group I and 52 patients (47%) of group II. The difference between two groups in terms of bowel obstruction localization was significant (χ²: 37.78, P < 0.0001). Group I had a significantly higher morbidity and mortality than group II (P < 0.01 and P < 0.001). Conclusions Non-tumoral cases causing intra-abdominal mechanical bowel obstruction occur mostly in younger people and in patients with previous surgical operation. Patients in older ages or who haven’t had any surgical intervention must be operated as soon as possible because of the high rate of malignancy.     

复方大承气汤联合肠梗阻导管治疗恶性肠梗阻的临床研究

目的:研究复方大承气汤联合经鼻型肠梗阻导管对恶性肠梗阻(MBO)的治疗效果、损伤的肠黏膜屏障修复和免疫紊乱的影响.方法:选择2018年7月—2019年8月我院收治的MBO患者30例,随机数表法分成对照组和中药组,各15例,两组均给予常规治疗,对照组在此基础上急症放置经鼻型肠梗阻导管,24 h后开始口服温开水100 mL...     

肠梗阻导管治疗肠梗阻--附36例报告

目的:探讨肠梗阻导管治疗肠梗阻临床疗效.方法:选择36例肠梗阻患者,按入院时间分为对照组和导管组.对照组给予常规中西医结合治疗,导管组在此基础上应用肠梗阻导管治疗.结果:导管组48 h腹痛和腹胀的缓解率为89%,对照组为61%(P＜0.05),导管组48h肛门恢复排气、排便比率为100%,对照组为77.8%(P＜0.05),导管组中转手术率为5.6%,对照组为22.2%(P＜0.05).结论:在中西医结合治疗各种类型肠梗阻时,配合应用肠梗阻导管,可明显改善临床症状,降低手术率.     

5-氟尿嘧啶加奥曲肽对乳腺癌细胞凋亡的影响

目的 探讨５－氟尿嘧啶（５－ＦＵ）加奥曲肽（善得定）对乳腺癌细胞凋亡的影响。方法取手术切除的１６例乳腺癌标本,制备癌单细胞悬液。每例癌细胞均分成４组：５－ＦＵ组（加入５－ＦＵ１０μｇ／ｍｌ）、善得定组（加入善得定０．１μｇ／ｍｌ）、５－ＦＵ加善得定组（加入５－ＦＵ１０μｇ／ｍｌ、善和定０１μｇ／ｍｌ）及对照组（不加任何药物）。用ＤＮＡ断端标记法（ＴＤＴ法）检测乳腺癌细胞癌细胞凋亡率。结果 １６例标     

Intestinal transplantation before and after the introduction of sirolimus

INTRODUCTION: Small bowel transplantation has been limited by high rates of rejection and graft loss. In June 2000, we began using sirolimus, an immunosuppression agent with proven efficacy in kidney transplantation. We reviewed results among intestinal transplant recipients before and after the introduction of sirolimus. METHODS: Thirty-one intestinal transplants were performed in 29 patients at our center between July 1998 and April 2001. All patients were followed for at least 30 days posttransplant. In the first 19 transplants (group 1), patients received tacrolimus, steroids, and antibody induction therapy (either daclizumab or OKT3). In the next 12 consecutive transplants (group 2), patients received tacrolimus, steroids, basiliximab, and sirolimus. RESULTS: Eighteen children (7 males and 11 females, mean age 2.1+/-2.2 years) and 11 adults (9 males and 2 females, mean age 38.1+/-12.4 years) underwent transplantation. All patients survived transplantation. The overall reoperation rate was 1.7 procedures per patient in group 1 and 1.1 procedures per patient in group 2. The most common indications were abscess (n=7), planned second look (n=7), leaks/fistulas (n=6), dehiscence (n=6), obstruction (n=4), ischemic bowel (n=3), perforations (n=3), stomal complications (n=3), and graft removal (n=3). The incidence of biopsy-proven rejection in the first 30 days was 73.7% in group 1 and 16.7% in group 2 (P<0.002). Sirolimus was temporarily held or discontinued in 66.7% of patients. Actuarial 1-year graft survival was 91.7% with sirolimus and 57.9% without sirolimus (P<0.04). Actuarial 1-year patient survival was 91.7% with sirolimus and 79% without sirolimus (P=0.12). CONCLUSIONS: An immunosuppressive regimen that includes sirolimus has improved graft survival. Furthermore, this regimen has significantly decreased the incidence of early rejection and has eliminated early graft loss caused by fulminant rejection.     

Post-operative small bowel obstruction: spiral computed tomography

INTRODUCTION: The aim of this study was to evaluate prospectively the impact of the routine use of abdominal spiral computed tomography (SCT) in patients with postoperative small bowel obstruction (SBO) for whom initial conservative treatment was proposed. PATIENTS AND METHODS: We have compared the management of SBO in patients with clinical stable condition in two successive periods : from 1989 to 1998, 127 patients (preSCT group) for whom management was based on standard clinical-biological-radiological assessment (CBRA) et from 1999 to 2000, 30 patients (SCT group) for whom management included SCT. The decision of surgical team was correlated with the type of small bowel obstruction at laparotomy : closed-loop obstruction without intestinal necrosis (true-positive), intestinal necrosis as a consequence of delayed diagnosis defined as false-negative, diffuse adhesion defined as false-positive et patient non operated defined as true-negative. RESULTS: Among the 127 patients from the preSCT group, 87 were treated conservatively and 40 were operated : SBO with closed-loop obstruction without intestinal necrosis (n = 29,72%), SBO with diffuse adhesion (n = 4, 10%) and SBO with intestinal necrosis (n = 7, 17%). Among the 30 patients from the SCT group, 16 were treated conservatively and 14 were operated: SBO with closed-loop obstruction without intestinal necrosis (n = 8, 57%), SBO with diffuse adhesion (n = 6,43%) and SBO with intestinal necrosis (n = 0,0%; NS). Both groups were similar for rates of patients with SBO with or without necrosis and rate of patients treated conservatively (NS). In SCT group, there was significantly more patients operated for diffuse adhesions (p < 0,01). Negative predictive value of CBRA + TDM was significantly higher than those of CBRA alone (p = 0,041). CONCLUSION: Due to a very high sensibility, TDM increase probably the rate of early laparotomies, maybe unnecessary, in patients without any sign of SBO due to closed-loop obstruction. Thus, systematic use of TDM in patients with clinical suspicion of SBO remains to be evaluated.