1例肠穿孔患者全麻肌松效果不良的报道

近期，我院收治了1例消化道穿孔并发急性腹膜炎、脓毒血症患者。在全麻下行剖腹探查术时，发现在使用肌松剂时(先使用非去极化肌松剂，后改用去极化肌松剂)患者腹壁无法松弛。现报道如下：     

结直肠癌伴穿孔的诊治体会

目的：探讨有效地预防结、直肠癌伴穿孔的发生及合理治疗结、直肠癌伴穿孔的方法。方法：用X2检验分析742例患者的5年生存率与其中的11例伴穿孔患者的5年生存率（所有病例均随访5年以上）。结果：全部742例结、直肠癌患者的5年生存率为58.6％。11例伴穿孔患者的5年生存率仅为18.2％。4例伴急性穿孔患者中的3例有诱发穿孔的因素。穿孔的部位大多发生在左侧结肠；其病理类型多数为粘液腺癌。结论:结、直肠癌伴穿孔患者的预后很差，在诊治过程中避免医源性的诱发穿孔因素值得重视；特别是结、直肠癌伴不全性梗阻时，要慎重选择检查手段及清洁肠道准备的方法。     

膀胱直肠陷凹疝致肠穿孔一例

【病例】　男 ,46岁。因突发性腹痛伴恶心、呕吐 15小时急诊入院。既往无腹部手术、外伤及腹痛史。查体 :生命体征平稳。腹部稍饱满 ,无胃肠型及蠕动波 ,脐下部压痛 ,无反跳痛及肌紧张 ,肠鸣音正常。血白细胞 9 3× 10 9/L ,中性粒细胞 0 85 ,尿常规未见异常。立位腹部X线平片     

腹腔镜与开腹手术治疗胃肠穿孔的临床疗效比较

选取2012年1月²014年1月我院收治的胃肠穿孔患者84例为研究对象,根据随机数字分组法将患者均分为观察组和对照组各42例。对照组采取开腹手术治疗,观察组采取腹腔镜手术治疗。比较两组患者术后并发症发生情况和手术各指标变化情况。结果观察组并发症发生率显著低于对照组,差异具有统计学意义(P<0.05)。观察组患者在术中出血量、术后排气时间、住院时间方面均优于对照组,差异具有统计学意义(P<0.05)。腹腔镜手术治疗胃肠穿孔疗效确切,术中出血量少,术后恢复排气时间短,住院时间短,可作为临床治疗胃肠穿孔的首选方法。     

急性胃肠穿孔的急诊治疗探讨

目的探究急性胃肠穿孔急诊治疗方法及其效果,总结临床治疗经验。方法对我院2014年1月至2015年12月接收的60例急性胃肠穿孔患者进行急诊治疗,根据患者的临床状况进行手术,对其治疗效果进行分析。结果 60例患者中有59例患者顺利完成手术,并恢复良好,1例患者因为穿孔严重,且病发至救治时间过久,导致患者失血过多而死亡;59例恢复的患者中有1例切口裂开,2例出现切口感染,1例吻合口瘘,并发症发生率为6.77%;并发症发生后我们及时对患者进行对症的干预,后患者并发症情况均消失,并未对患者产生严重影响。结论急性胃肠穿孔应该细致对患者情况进行判断,同时进行相应的手术治疗,手术积极预防并发症,帮助患者得到有效的恢复。     

射频治疗子宫颈息肉致迟发性肠穿孔临床分析

目的探讨分析射频治疗子宫颈息肉导致迟发性肠穿孔的原因。方法对我院1例子宫颈息肉的患者行射频微创术治疗后,并发迟发性肠穿孔与治疗后未引起并发症的患者的病例资料进行回顾分析。结果对患者的病例进行分析后发现系手术者操作时间长,电频功率小所致。对迟发性肠穿孔的患者进行肠修补及对症治疗,伤愈出院。结论目前,射频微创治疗在临床上引起较为严重并发症的均为术者操作不当,未发现射频微创术的技术性缺陷,值得推广使用。     

结肠镜检查有哪些并发症? 应采取什么措施?

答:结肠镜检查并发症及采取措施有:(1)肠穿孔,一般采用禁食、静脉输液、胃肠减压及给予抗生素,必要时手术治疗;(2)感染,由于结肠镜被污染造成细菌、病毒、寄生虫的传播,引起交叉感染。如发生感染,应抗感染治疗。并应在每次检查后将结     

新生儿坏死性小肠结肠炎肠穿孔与肠未穿孔患儿术后结局的对比研究CSCD

目的对比新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)肠穿孔与肠未穿孔患儿手术治疗后转归情况,为NEC手术时机的选择及术后治疗提供参考。方法回顾性分析2009年8月至2019年8月中国人民解放军总医院第七医学中心儿科医学部新生儿外科收治的237例经手术治疗的NEC患儿临床资料。按照是否发生肠穿孔分为肠未穿孔组(172例)与肠穿孔组(65例),收集两组患儿术中所见坏死肠管长度、手术后实施肠内及肠外营养时间、呼吸机使用时间、NICU入住时间、术后并发症以及预后情况。结果NEC肠未穿孔组172例中,治愈124例(124/172,72.1%),死亡48例(48/172,27.9%);肠穿孔组65例中,治愈48例(48/65,73.8%),死亡17例(17/65,26.2%)。两组术中所见坏死肠管长度以及术后肠外营养时间、肠内营养时间、呼吸机使用时间、NICU入住时间及术后并发症比较,差异均有统计学意义(P<0.05)。Bell分期为ⅢA与ⅢB期的患儿病死率比较,差异有统计学意义(χ^(2)=4.731,P=0.030)。结论NEC肠未穿孔的患儿可能存在更多肠管坏死,术后并发症多,康复时间长。建议对于NEC肠未穿孔患儿,可根据患儿临床实际情况探讨更合适的手术指征。     

Diagnosis and treatment of spontaneous colonic perforation： Analysis of 10 cases

AIM： To investigate the etiology, diagnosis and treatment of spontaneous perforation of the colon.
METHODS： The clinical data of 10 cases of spontaneous perforation of the colon, observed at Fuding hospital from January 2004 to December 2007, were analyzed retrospectively.
RESULTS： The mean age at onset was 65 years （range from 45 to 73）. Seven patients had a history of chronic constipation. All patients complained of sudden lower abdominal pain. The perforation occurred after coloclysis and administration of senna leaves in two patients. Nine patients had signs of peritoneal irritation. Seven cases underwent abdominal paracentesis, which was diagnostic in six. Only one case was definitely diagnosed prior to surgery. One patient underwent neoplasty of the colon, another a partial resection of colon, six a neoplasty of the colon plus sigmoid colostomy, and two underwent Hartmann surgery. All perforation sites were opposite to the mesenteric edge. The perforation sites were located on descending colon in one case, sigmoid colon in three cases, and rectosigmoid colon in six cases. In five patients, surgical pathological examination was consistent with the microscopical changes of colonic perforation caused by feces. Three patients died after surgery.
CONCLUSION： Spontaneous perforation of the colon most commonly occurs among the elderly with chronic constipation. Abdominal paracentesis is helpful for the diagnosis. The perforation site is located opposite to the mesenteric edge. Sigmoid colon and rectosigmoid colon are the most frequent locations. Neoplasty of the colon and sigmoid colostomy are the most frequent treatment. The prognosis is bad and the mortality rate after surgery is high.     

Subclinical peritonitis due to perforated sigmoid diverticulitis 14 years after heart-lung transplantation

Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and end-colostomy （Hartmann＇s procedure） were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigation of even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.