结肠动力不足致低位小肠麻痹性梗阻非手术治疗观察

目的:观察结肠动力不足导致小肠麻痹性梗阻的临床特征并观察中西医结合治疗效果。方法:结肠动力不足致低位小肠麻痹性梗阻住院的26例患者,分析其临床特征并分析其治疗经过。结果:10例无明确便秘病史,2例有1~2月便秘病史,14例有1年~10年便秘病史。主要症状有腹胀、腹痛、便秘、呕吐。发生肠梗阻的特点为突然出现低位回肠肠梗阻的症状、伴有结肠肠型和回肠蠕动波;腹部影像学表现特点为X腹部立位平片提示低位小肠梗阻,腹部CT提示结肠、甚至直肠扩张,时有粪石阻塞。通过影响支持治疗,并给予小承气汤灌肠、粪菌移植,待腹胀缓解后给予中药治疗,症状完全缓解。肠梗阻症状反复发作则行手术治疗。结论:结肠动力不足致低位小肠麻痹性梗阻治疗以中西医结合方法、恢复结肠动力的非手术治疗为主,对于长时间不能恢复者可以进行回肠造口手术,尽量不要行急诊全结肠切除手术,何时进行手术尚需进一步探讨。

Observation of Non-surgical Treatment of Low Intestinal Paralytic Obstruction Caused by Insufficient Colonic Motility

Objective:To observe the clinical characteristics of small intestinal paralytic obstruction caused by insufficient colonic motility and to observe the therapeutic effect of integrated traditional Chinese and western medicine. Methods: Twenty-six patients hospitalized with low small intestinal paralytic obstruction caused by lack of colonic motility were analyzed for their clinical characteristics and their treatment history. Results: There were 10 cases with no definite history of constipation, 2 cases with a history of constipation for 1 to 2 months, and 14 cases with a history of constipation for 1 to 10 years. The main symptoms are abdominal distension, abdominal pain, constipation, and vomiting. Small intestinal obstruction is characterized by the sudden appearance of low ileal intestinal obstruction, accompanied by colonic and ileal peristalsis wave. The abdominal imaging features: X abdominal verticalposition plain film radiography suggested low intestinal obstruction, and abdominal CT suggested colon or even rectal dilatation, sometimes dung stone blockages. By influencing supportive treatment, Xiaochengqi Decoction enema and fecal bacteria transplantation were given. After the abdominal distension was relieved, the patients were given method of combination of traditional Chinese and western medicine, with the symptoms completely relieved. Recurrent intestinal obstruction symptoms were treated with surgery. Conclusion: The treatment of low intestinal paralytic obstruction caused by lack of colonic motility is mainly based on the method of combination of traditional Chinese and western medicine and non-surgical treatment to restore colonic motility. For those who cannot recover for a long time, ileostomy can be performed, and emergency total colectomy should not be performed as far as possible. When to perform surgery still needs to be further explored.