穴位注射结合开塞露纳肛治疗腹部术后早期炎症性肠梗阻临床观察

目的:观察穴位注射结合开塞露纳肛治疗腹部术后早期炎症性肠梗阻的临床疗效。方法:将35例患者分为两组:治疗组19例,采用常规西医治疗,加双侧足三里穴位注射甲氧氯普胺+50%葡萄糖,结合开塞露纳肛;对照组16例,采用西医治疗。观察治疗3 d后两组患者的临床疗效。结果:两组疗效比较,治疗组在消除临床症状等方面与对照组比较差异有统计学意义(P<0.05)。结论:穴位注射结合开塞露纳肛治疗腹部术后早期炎症性肠梗阻疗效肯定,操作简单方便、实用性强、效果满意。     

Gastrointestinal peptide hormones during postoperative ileus

The hypothesis was that postoperative ileus might be caused by a disturbed balance between the motor-stimulating hormones, motilin and substance P, and the motorinhibitory hormone, vasoactive intestinal polypeptide, and that octreotide might prevent this disturbance and so ameliorate the ileus. In 15 conscious dogs with chronic gastro-intestinal electrodes, electrical activity was recorded and blood was drawn for radioimmunoassay of motilin, substance P, and vasoactive intestinal peptide (VIP) during fasting and after a liquid meal. Ileus was then induced by celiotomy and intestinal abrasion. During and after operation, five dogs received 154 mM NaCl only, five dogs octreotide, 0.19 µg/kg/hr, and five octreotide, 0.83 µg/kg/hr. Plasma levels of motilin, substance P, and VIP were changed little by operation, but cyclical increases in plasma motilin, which occurred preoperatively during phase III of the interdigestive myoelectric complex, were completely abolished postoperatively during ileus, as was the complex itself. Octreotide ameliorated the ileus and restored the interdigestive complexes, but it decreased plasma motilin and did not restore the cyclic increases in motilin found in health, nor did it alter plasma substance P and VIP. In conclusion, octreotide ameliorates postoperative ileus, but it does not do so by increasing plasma motilin or substance P or decreasing plasma VIP.This work was supported by USPHS NIH grants DK18278 and DK07198, a grant from Sandoz Pharmaceuticals, and the Mayo Foundation.An abstract of this work has been published inGastroenterology 103:1382, 1992, and was presented at the biennial meeting of the American Motility Society, September 13–17, 1992, in Lake Tahoe, California.     

PEG ileus

Summary A case of small bowel obstruction due to a lodged percutaneous endoscopic gastrostomy tube inner bumper is described. Most probably inner bumper lodgement in the terminal ileum is related to its size. Laparotomy was required to remove the bumper and relieve the obstruction. We suggest that all percutaneous endoscopic gastrostomy bumpers be retrieved endoscopically when the PEG tube is removed or replaced unless a collapsible inner bumper is used.     

Direct Observation with Double-Balloon Enteroscopy of an Intestinal Intramural Hematoma Resulting in Anticoagulant Ileus

In the case presented here, we have succeeded in describing the endoscopic findings of anticoagulant ileus and evaluated the degree of bleeding as well as ischemia through endoscopic observation. We have demonstrated that enteroscopy using the double-balloon method is a useful diagnostic tool in the evaluation of a patient suspected to have anticoagulant ileus.     

Value of CT in the diagnosis and management of gallstone ileus

AIM: To retrospectively establish the diagnostic criteria of gallstone ileus on CT, and to prospectively apply these criteria to determine the diagnostic accuracy of CT to confirm or exclude gallstone ileus in patients who presented with acute small bowel obstruction (SBO). Another purpose was to ascertain whether the size of ectopic gallstones would affect treatment strategy. METHODS: Fourteen CT scans in cases of proved gallstone ileus were evaluated retrospectively by two radiologists for the presence or absence of previously reported CT findings to establish the diagnostic criteria. These criteria were applied in a prospective contrast enhanced CT study of 165 patients with acute SBO, which included those 14 cases of gallstone ileus. The hard copy images of 165 CT studies were reviewed by a different group of two radiologists but without previous knowledge of the patient's final diagnosis. All CT data were further analyzed to determine the diagnostic accuracy of gallstone ileus when using CT in prospective evaluation of acute SBO. The size of ectopic gallstone on CT was correlated with the clinical course. RESULTS: The diagnostic criteria of gallstone ileus on CT were established retrospectively, which included: (1) SBO; (2) ectopic gallstone; either rim-calcified or total-calcified; (3) abnormal gall bladder with complete air collection, presence of air-fluid level, or fluid accumulation with irregular wall. Prospectively, CT confirmed the diagnosis in 13 cases of gallstone ileus with these three criteria. Only one false negative case could be identified. The remaining 151 patients are true negative cases and no false positive case could be disclosed. The overall sensitivity, specificity and accuracy of CT in diagnosing gallstone ileus were 93%, 100%; and 99%, respectively. Surgical exploration was performed in 13 patients of gallstone ileus with ectopic stones sized larger than 3 cm. One patient recovered uneventfully following conservative treatment with an ectopic stone sized 2 cm in the long axis. CONCLUSION: Contrast enhanced CT imaging offered crucial evidence not only for the diagnosis of gallstone ileus but also for decision making in management strategy.     

电针治疗大鼠腹部术后肠麻痹实验研究

目的观察电针治疗大鼠腹部术后肠麻痹疗效。方法 72只健康清洁级SD大鼠,随机分为模型组、电针组和假手术组,每组再随机分为24、72、120h组,每组8只。模型组和电针组大鼠制备成术后肠麻痹模型,假手术组仅行剖腹探查术。电针组于造模成功后2h予以电针针刺大鼠后足的足三里以及上巨虚穴20min,每间隔12h 1次,至观察结束,术后第24、72和120h检测墨汁推进率及血清胃动素水平。结果电针组72h点墨汁推进率明显高于模型组（P〈0.05）,血清胃动素在72h和120 h点明显高于模型组（P〈0.05,P〈0.01）。结论电针治疗能改善大鼠腹部术后肠麻痹状态,促进肠动力恢复。     

电针对腹部术后大鼠肠麻痹治疗作用的实验研究

目的：探讨电针对大鼠腹部术后肠麻痹的治疗效果。方法：将72只健康清洁级SD大鼠,随机分模型组、治疗组和假手术组,每组再随机分为24h、72h、120h组,每组8只。模型组和电针组大鼠制备成术后肠麻痹模型,假手术组仅行剖腹探查术。治疗组于造模成功后2h予以电针针刺大鼠后足的足三里以及上巨虚穴20min,每间隔12h 一次,至观察结束,在术后第24h,72h及120h检测墨汁推进率及血清胃动素水平。结果:治疗组在72h点墨汁推进率明显高于模型组((P<0.05),血清胃动素在72h和120h点明显高于模型组(P<0.05)。结论：电针治疗能改善大鼠腹部术后肠麻痹状态,促进肠动力的恢复。     

Abdominal Surgery- and Trephination-Induced Delay in Gastric Emptying is Prevented by Intracisternal Injection of CRF Antagonist in the Rat

The role of endogenous corticotropin-releasing factor (CRF) in mediating surgery-induced delay in gastric emptying of a noncaloric solution was studied in rats using intracisternal injection of a CRF antagonist, α-helical CRF9-41. Intracisternal injections and surgery (abdominal or trephination) were performed under ether anesthesia. After rats recovered from anesthesia, a methylcellulose phenol red solution was administered oropharyngeally and gastric emptying was measured 20 minutes later. Laparotomy, followed by exteriorization of the cecum for 60 seconds (abdominal surgery), trephination, intracisternal injection, of CRF (130 pmol), and ether exposure alone for 120 to 140 or 70 to 80 seconds, inhibited gastric emptying by 83%, 81%, 60%, 56%, and 32%, respectively, as compared with an untreated control group. Intracisternal injection of α-helical CRF9-41 significantly enhanced gastric emptying by 27% and prevented by 79% to 87% the inhibition of gastric emptying induced by intracisternal injection of CRF and ether exposure (70–80 s) alone or combined with abdominal surgery. Intracisternal injection of the CRF antagonist (13–26 nmol) dose dependently prevented ether-induced (120–140 s) and trephination-induced inhibition of gastric emptying. These results suggest that central CRF may be involved in mediating the acute postoperative delay in gastric emptying.     

Laparoscopic versus conventional colorectal resection: a prospective randomised study of postoperative ileus and early postoperative feeding

Background: A shorter duration of postoperative ileus and earlier oral alimentation of patients may be a clinically relevant benefit of laparoscopic compared with conventional colorectal resection. Patients/Methods: A total of 60 patients were randomised to either laparoscopic (n=30) or conventional (n=30) resection of colorectal tumours. Major endpoints were the postoperative time to the first bowel movement and the time until oral feeding without parenteral alimentation was tolerated. Minor endpoints were the postoperative interval to the first peristalsis and first passage of flatus, the distribution of radio-opaque markers in abdominal radiographs on day 3 and day 5 and the incidence of postoperative vomiting. Results: Age, gender, ASA-classification and type of resection were comparable in thetwo groups. Peristalsis was first noticed 26±9 h after laparoscopic and 38±17 h after conventional colorectal resection (P<0.01). First flatus occurred 50±19 h after laparoscopic and 79±21 h after conventional surgery (P<0.01). The incidence of postoperative vomiting was similar in both groups. Three days after surgery radio-opaque markers were found more often in the right colon (P<0.01) and less often in the small intestine (P<0.05) in laparoscopic compared with conventional patients. Five days after laparoscopic surgery, more markers had reached the left colon (P<0.05). The first bowel movement occurred 70±32 h after laparoscopic and 91±22 h after conventional resection (P<0.01). Oral feeding without additional parenteral alimentation was tolerated 3.3±0.7 days after laparoscopic and 5.0±1.5 days after conventional surgery (P<0.01). Conclusion: The shorter duration of postoperative ileus allows earlier restoration of oral feeding after laparoscopic compared with conventional colorectal resection and therefore increases quality of life immediately after resection of colorectal tumours. Received: 17 December 1997     

Paralytic ileus as a prodromal symptom of the neuroleptic malignant syndrome

A schizophrenic patient receiving neuroleptic treatment developed paralytic ileus followed by the neuroleptic malignant syndrome (NMS). The patient had previously experienced two NMS episodes, one of which was also accompanied by paralytic ileus. It is suggested that paralytic ileus can occur as a prodromal symptom of NMS. Therefore, if this symptom is observed in patients receiving neuroleptic treament, especially those with a past history of NMS, careful attention should be paid to the possible development of NMS.