IMPROVED BALLOON‐TIPPED TRANS‐ANAL ILEUS TUBE

Background: For management of bowel obstruction due to colorectal cancer, endoscopic trans‐anal decompression technique has been first reported by Lelcuk et al. in 1986 using balloon dilatation technique. Since then, various types of trans‐anal decompression tubes have been clinically used for patients suffering from left side obstructing colorectal cancer as an emergent decompressing device. At present, two types of trans‐anal ileus tube (trans‐anal decompression tube) have been available for clinical use, but they have two main problems that are late colon perforations caused by the tip of the tube and tube obstruction by stool. Methods: Analysis on three late colon perforations experienced with the use of conventional devices drew possible improvements to make a trans‐anal ileus tube less harmful. To overcome the pitfalls inherent to conventional tubes, the author has developed an improved trans‐anal ileus tube with a balloon installed at the very end of the tube (‘balloon‐tipped type’) made of silicone, measuring 1200 or 1700 mm in total length and 22 Fr in outer diameter. It has been used for 12 cases with obstructing colorectal cancer etc. and its outcomes were compared with those obtained by the use of conventional trans‐anal ileus tube. Results: No late perforations have been encountered, but tube obstruction did occur in one of 12 cases. Conclusion: The new trans‐anal ileus tube with a balloon installed at the tip of ileus tube is considered to be safer and especially effective in preventing late colon perforation and tube obstruction.     

9例结石性肠梗阻的诊断与治疗

目的 探讨结石性肠梗阻的诊断及治疗。方法 比较腹部平片和B超的术前诊断率。随访患者以了解不同手术方法的得失。结果 腹部平片术前诊断率为22％,辅以B超则上升为66％。4例Ⅰ期手术和3例Ⅱ期手术患者无死亡。无胆管炎发作。结论 仅靠腹部平片易漏诊,辅以B超则能提高术前诊断率。争取回期手术切除胆囊、闭合胆肠瘘,如有困难,则动员患者6-8周后Ⅱ期手术。     

乳腺癌改良根治术后自帖式敷料包扎刀口35例临床观察

目的:探讨乳腺癌改良根治术后自帖式敷料包扎刀口的临床效果。方法:将70例乳腺癌改良根治术患者随机分为两组,对创面不同包扎方式进行对比。结果:自帖式敷帖对术后创面包扎并发症少于传统绷带加压包扎方式。结论:自帖式敷帖包扎乳腺癌改良根治术后创面,能预防切口并发症的发生。     

UB-I粘结剂粘结面的微形态观察

目的：研究UB-Ⅰ粘结剂的粘结界面和粘结表面的微形态特点。方法：用扫描电子显微镜观察UB-Ⅰ和牙本质的粘结界面和粘结表面。结果：UB-Ⅰ粘结剂在牙本质小管内可聚合形成树脂突，在牙本质小管内的树脂突表面有树脂侧枝呈树枝状横行排列，并且和相邻的树脂突相连接，在牙本质和复合树脂之间有杂合层形成。结论：UB-Ⅰ粘合剂具有良好的渗透性，与牙本质之间可以形成良好的机械嵌合。     

Der operierte mechanische Ileus

Zusammenfassung Von 1972 bis 1983 wurden 351 Patienten wegen eines mechanischen Dünndarm- (n = 256) bzw. Dickdarmileus (n = 95) operiert. Die chirurgische Komplikationsrate betrug beim Dünndarmverschluß 28,1 bzw. beim Dickdarmileus 24,3%, wobei am häufigsten Anastomosendehiscen-zen nach Resektionen (17,7% bzw. 53,8%), Enterotomien (5,8%/27,2%), Platzbäuche (3,5%/4,2%) und ein Re-Ileus (5,5%/3,2%) vorlagen. Die internistischen Komplikationen (postop. Pneumonien, Lungenembolien, kardiale Dekompensationen etc.) betrugen 17,9% bzw. 22,1 %. Die perioperative Letalität lag beim Dünndarmileus bei 20,6% und beim Dickdarmileus bei 33,4%. Als Schlußfolgerungen dieser retrospektiven Analyse ergaben sich die frühzeitige, perioperative, intensiv-medizinische Behandlung, die generelle Thrombose-, Pneumonie- und StreBulcusprophylaxe, die exakte, präoperative Röntgendiagnostik, die strenge Indikationsstellung für Enterotomien und Resektionen, das dreizeitige Vorgehen beim linksseitigen Dickdarmileus, die Inkontinuitätsresektion nach Hartmann bei entzündlichen Prozessen im Sigmabereich und die innere Dünndarmschienung bei Peritonitis bzw. ausgedehnten Adhäsionen. Dadurch konnte seit Anfang 1984 die Komplikationsbzw. Letalitätsrate beim Dünndarmileus (n = 64) auf 9,4% bzw. 4,7% und beim Dickdarmileus (n = 20) auf 10% bzw. 5% gesenkt werden.

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Experiences with operations of mechanical ileus

Summary Between 1972 and 1983 a total of 351 patients was operated suffering from mechanical occlusion of the small intestine (n = 256) and of the colon (n = 95). The surgical complication rate amounted to 28.1% in cases of small intestine ileus and to 24.3% in cases of colon ileus; the most frequent complications were anastomotic dehiscences following resections (small intestine 17.7%/colon 33.8%), enterotomies (5.8%/27.2%), abdominal wall ruptures (3.5%/4.2%) and re-ileus (5.5%/3.2%). The medical complication rate (postop. pneumonia, pulmonary embolism, cardial decompensation etc.) amounted to 17.7% resp. 22.1%. All these complications carried a mortality of 20.6% in small intestine ileus and of 30.4% in colon ileus. The consequences of this retrospective analysis resulted in: early intensive care treatment, general perioperative thrombosis-, pneumonia- and stress ulcer prophylaxis, exact preoperative radiological diagnosis, strict indications for enterotomies and resections, sole transversostomy in stage of ileus for the left-sided colon obstruction caused by carcinoma, discontinuity resection by Hartmann in cases of inflammatory or perforated large bowel stenoses and tube decompression of the small bowel in cases of peritonitis or wide-spread adhesions. Since 1984 we could prospectively decrease the complication resp. mortality rate of the small intestine ileus (n = 64) to 9.4% resp. 4.7% and of the colon ileus (n = 20) to 10% resp. 5%.

     

炎性肠梗阻15例诊治体会

目的探讨炎性肠梗阻的诊断和治疗。方法分析15例炎性肠梗阻的临床特点和治疗。结果15例经保守治疗,其中1例因肠扭转缺血损伤严重,出现全身性炎症反应综合征致多脏器衰竭死亡外,其他病例均痊愈,平均治愈时间为12.6d。结论炎症性肠梗阻由无菌性炎症致广泛肠粘连引起,应用小剂量激素减缓炎症反应,抗生素防止肠道菌群易位,经内镜逆行置入肠减压管及营养支持治疗,多数病例可保守治愈。     

组织黏合剂闭合血管影响因素的血液流变学研究

目的通过血液流变学研究组织黏合剂N-丁基-2-氰丙烯酸盐在模拟血管中的实际行为，分析影响其闭合血管的主要因素，找到发挥作用的最佳条件。方法利用聚四氟乙烯管建立血流模拟装置，分别研究血管直径、血流速度以及组织黏合剂配比浓度这三个因素对组织黏合剂闭合血管的影响。结果组织黏合剂与碘油1：1配比混合物1．0ml快速注射至聚四氟乙烯管内可以完全阻塞血流速度15cm／s、直径0．4cm的以及血流速度10cm／s且直径0．6cm的血流。当管腔直径增加至0．8cm或血流速度加快为20cm／s时，血流只是部分闭塞。改变组织黏合剂与碘油配比为0．5：0．8以及0．5：1．0，则注射后聚合体断裂成碎片状。结论实验验证了随着血管直径增大、血流速度加快及配比浓度降低，组织黏合剂闭合血管的效应下降，以供临床定量参考。     

氟氢酸酸蚀及偶联剂的应用对烤瓷——树脂粘结强度的影响

目的：评价酸蚀及化学偶联剂对树脂—烤瓷粘结强度的影响。方法：烤瓷试件分７组用５％氟氢酸分别酸蚀０～１８０ｓ，然后一半使用偶联剂，另一半不使用偶联剂，与树脂粘结后测试剪切粘结强度。结果：无偶联剂组酸蚀后可使瓷—树脂粘结强度达到３０ＭＰａ（１５０ｓ），对照组为３ＭＰａ；单独使用偶联剂可使粘结强度达２５．２ＭＰａ，若结合酸蚀剂最高可达３４．３ＭＰａ，但酸蚀后使用偶联剂，酸蚀时间对粘结强度无明显影响；结论：瓷酸蚀是瓷粘结修复中重要的处理方法；偶联剂的使用有利于提高粘结强度，并可用较短的酸蚀时间获得理想的粘结强度。     

The direct early diagnosis of cystic fibrosis by the detection of the deltaF508 CFTR gene mutation in a prematurely delivered boy

The suspicion of prenatal meconium ileus syndrome was raised in a pregnancy in a family with no history of cystic fibrosis because of significantly higher maternal serum alpha-fetoprotein in the 16th and 19th week of gestation, dispersed areas with increased echogenity in the fetal abdomen, slight fetal ascites in the 24th-25th weeks of gestation, decreased amniotic fluid gamma-glutamyltranspeptidase (GGT) activity and alpha-fetoprotein level in the 25th-26th weeks, and normal 46,XY karotype of the fetus. The detection of a homozygous deltaF508 cystic fibrosis transmembrane regulator (CFTR) gene mutation, by means of PCR from a small amount of white blood cells and urine sediment cells, substantiated the diagnosis of cystic fibrosis in a prematurely delivered boy in the 28th week of gestation. The repeated sweat test was unsuccessful. The autopsy examination confirmed the diagnosis of cystic fibrosis. Fetal meconium ileus syndrome was complicated by peritonitis and by formation of a meconium pseudocyst. Direct PCR typing improves postnatal diagnostic possibilities in the early neonatal period in prematurely delivered babies when the sweat test is difficult to perform.     

Postoperative Ileus after Stimulation with Probiotics before Ileostomy Closure

Loop ileostomy closure after colorectal surgery is often associated with Postoperative ileus, with an incidence between 13–20%. The aim of this study is to evaluate the efficacy and safety of preoperative stimulation of the efferent loop with probiotics prior to ileostomy closure in patients operated on for colorectal carcinoma. For this, a prospective, randomized, double-blind, controlled study is designed. All patients who underwent surgery for colorectal carcinoma with loop ileostomy were included. Randomized and divided into two groups, 34 cases and 35 controls were included in the study. Postoperative ileus, the need for nasogastric tube insertion, the time required to begin tolerating a diet, restoration of bowel function, and duration of hospital stay were evaluated. The incidence of Postoperative ileus was similar in both groups, 9/34 patients stimulated with probiotics and 10/35 in the control group (CG) with a p = 0.192. The comparative analysis showed a direct relationship between Postoperative ileus after oncological surgery and Postoperative ileus after reconstruction surgery, independently of stimulation. Postoperative ileus after closure ileostomy is independent of stimulation of the ileostomy with probiotics through the efferent loop. There seem to be a relationship between Postoperative ileus after reconstruction and the previous existence of Postoperative ileus after colorectal cancer surgery.