小肠内固定术治疗广泛性粘连性肠梗阻的技术要点

目的提高小肠内固定术治疗广泛性粘连性肠梗阻的疗效。方法回顾性分析36例施行小肠内固定术的广泛性粘连性肠梗阻患者的临床资料。结果36例经年以上随访均无复发,疗效满意。结论彻底分离粘连、选择合适的内支撑管、准确掌握插入部位和方法、关腹前把全部小肠做大弧度排列是小肠内固定术的技术要点。     

小肠内置管排列术治疗重症粘连性肠梗阻16例临床分析

目的探讨小肠内置管排列术治疗重症粘连性肠梗阻的方法及效果。方法选择16例重症粘连性肠梗阻患者行肠粘连松解及小肠内置管排列术治疗,对患者的临床资料进行回顾性分析。结果 16例均顺利完成手术,术后2~3周逐渐分段拔除小肠排列管,康复出院。全部患者均获经1~4 a随访,无肠梗阻复发病例。结论严格掌握手术适应证,规范进行手术操作及精心的术后处理,小肠内置管排列术是重症粘连性肠梗阻的有效治疗和预防术式。     

急性粘连性肠梗阻手术时机的探讨

目的探讨急性粘连性肠梗阻手术时机的选择。方法回顾性分析我院1998年1月～2003年12月经手术治疗的88例急性粘连性肠梗阻的临床资料。其中，因入院时即诊断肠绞窄而行急诊手术5例；先保守观察后手术治疗83例：腹部体征加重，辅助检查提示向绞窄性肠梗阻发展45例；造影剂24h内未能到达结肠12例；保守治疗4～5d无好转15例；肠梗阻反复发作11例。手术方式包括粘连松解术80例，坏死肠管切除吻合术4例，肠短路吻合术3例，小肠内固定术l例。结果术后发生肠外瘘1例，经保守治疗45d后痊愈；切口感染10例，经1T期缝合后治愈。结论急性粘连性肠梗阻在保守治疗过程中应及时发现早期肠绞窄的线索，果断决定手术治疗，手术时机宜早勿迟，手术指征宜宽勿严。     

小肠插管内固定排列术治疗广泛粘连性完全性肠梗阻

目的探讨小肠插管内固定排列术治疗广泛粘连性完全性肠梗阻的效果。方法对31例广泛粘连性完全性肠梗阻患者行肠粘连松解及小肠插管内固定排列术,回顾性分析患者的临床资料。结果所有患者均康复出院,随访2~5年,无1例出现不完全肠梗阻症状。结论采用小肠插管内固定排列术治疗广泛粘连性完全性肠梗阻,方法简单、并发症少、疗效确切,远期效果好,值得临床进一步完善推广。     

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肠粘连是导致小肠梗阻的主要原因,对于广泛粘连而反复梗阻发作的复杂病例,处理不当则会造成严重后果[1]。我们采用米-阿管行小肠内固定术治疗32例复杂性粘连肠梗阻取得满意效果。报告如下。1临床资料1.1一般资料2000年1月至2010年6月我院收治复杂性粘连性肠梗阻32例,男性28例,女性4例。年龄16～71     

小肠悬挂排列术治疗广泛粘连性肠梗阻

目的探讨小肠悬挂排列术治疗广泛粘连性肠梗阻的手术经验。方法1990年2月至2006年2月对术中诊断为广泛粘连性肠梗阻的27例患者行小肠悬挂排列术。结果本组27例痊愈,获随访15例,随访时间3个月至12年,无因粘连性肠梗阻而再次入院手术者。结论小肠悬挂排列术是预防广泛粘连性肠梗阻再发的有效术式。     

腹腔镜粘连公解术治疗粘连性肠梗阻12例报告

目的探讨腹腔镜粘连松解术治疗粘连性肠梗阻的方法,提高粘连性肠梗阻的治疗效果。方法利用腹腔镜粘连松解术治疗粘连性肠梗阻１２例,其中因束带粘致小肠梗阻,在腹腔镜下切除束带;小肠与腹壁粘连成角及小肠、网膜与腹壁粘连,用电凝分离剪、分离钳或超声刀分离与腹壁的粘连。结果全部病例均经腹腔镜行粘连松解术,无手术并发症发生。随防１～３６个月,均无梗阻症状复发。结论利用腹腔镜粘连松解术有选择性地治疗粘连性肠梗阻     

碘化油小肠造影在粘连性肠梗阻诊断及治疗决策中的价值

目的观察碘化油小肠造影在粘连性肠梗阻诊疗中的作用。方法220例患者行碘化油小肠造影,通过腹部X线摄片动态观察造影剂在胃肠道中的位置及通过情况,以确定梗阻部位以及梗阻是否完全,从而确定治疗方法。结果118例不全性肠梗阻（造影剂在24 h内到达结肠）给予保守治疗,116例症状消失,2例症状加重经手术治疗后痊愈;另102例完全性肠梗阻（24 h后造影剂不能到达结肠）,98例行手术治疗痊愈,4例拒绝手术,保守治疗成功。结论碘化油小肠造影在对粘连性、非绞窄性肠梗阻明确梗阻部位及治疗方法的选择方面有很好的作用。     

小肠内支撑排列术治疗多次术后广泛粘连性肠梗阻

目的总结小肠内支撑排列术治疗多次术后广泛粘连性肠梗阻的临床经验与疗效。方法回顾分析1995～2003年间采用小肠内支撑排列术治疗多次术后广泛粘连性肠梗阻21例患者的临床资料。结果20例患者术后无并发症发生,顺利康复。1例肠坏死肠切除病例术后发生肠瘘,经内支撑管持续低负压引流后迅速痊愈。19例患者经1～7年随访,均未出现肠粘连和肠梗阻。结论对多次手术(2次以上)后出现广泛粘连性肠梗阻患者,小肠内支撑排列术是一种操作简单、安全而有效的术式。     

广泛粘连性肠梗阻的再手术治疗(附28例报告)

目的：提高广泛粘连性肠梗阻的治疗效果，预防粘连性肠梗阻复发。方法：分析我院1994年1月至2000年5月6年间手术治疗28例广泛粘连性肠梗阻的临床资料。结果：手术后无肠梗阻复发，术后8例发生切口感染，无手术死亡及肠瘘发生。结论：把握好手术时机是提高粘连性肠梗阻治疗效果的关键，肠排列术是预防粘连性肠梗阻的一个有效方法。     

Transmesenteric small bowel plication or intraluminal tube stenting. Indications and contraindications.

Controversy exists as to the efficacy of transmesenteric intestinal plication or long tube stenting of the small bowel in the treatment of severe intestinal adhesions and in late small bowel obstruction.We reviewed our experience with these procedures over a 12 year period with complete follow-up data on 92 per cent of the patients. There were 28 modified Childs-Phillips plications and 37 intraluminal tube decompressions and stenting. For comparison we reviewed 107 cases of small bowel obstruction treated by simple lysis of adhesions.Three deaths and one small bowel fistula were associated with the modified Childs-Phillips procedure; none was directly related to the plication. Three patients required reoperation within the 1st postoperative week for technical reasons. No late operations for recurrent small bowel obstruction were required.One death and one reoperation for bowel obstruction were associated with but not directly related to the Baker tube stenting.Four deaths were associated with simple lysis. Seven patients required reoperation for late recurrent small bowel obstruction.Modified Childs-Phillips transmesenteric plication using nonabsorbable sutures is recommended in cases of severe visceral and parietal peritoneal damage but not in cases of distention and severe ileus of the small bowel or acute generalized peritonitis.Baker tube jejunostomy with decompression and splinting of the small bowel is recommended with massive distention and ileus of the small bowel. Peritonitis is not a contraindication. In our experience fewer short-term complications have occurred after long tube decompression and stenting than after modified Childs-Phillips plication. Measures to avoid these complications are presented. With proper indications, modified Childs-Phillips plication and intraluminal tube stenting are safe and efficient in preventing reobstruction.     

NASOGASTROINTESTINAL INTRALUMINAL TUBE STENTING IN THE PREVENTION OF RECURRENT SMALL BOWEL OBSTRUCTION

Nasogastrointestinal intraluminal tube stenting using a Dennis tube (Sherwood Medical St Louis, Missouri, USA) was performed on 25 patients. Two intubations were for midgut volvulus, 13 for small intestinal obstruction after extensive adhesolysis, and 10 as an adjunct to the operative management of enterocutaneous fistulae following extensive adhesolysis, resection and anastomosis. No patient developed recurrent small bowel obstruction for periods up to three years after operation. Use of an intraluminal tube stent in preventing recurrent small bowel obstruction due to adhesions is safe and effective when used on appropriately selected patients. Its effectiveness should be more widely recognized.     

Nonoperative management of small-bowel obstruction with endoscopic long intestinal tube placement

Intestinal obstruction remains a major cause of morbidity and mortality in surgical patients. We reviewed the records of 77 patients with mechanical small-bowel obstruction who were treated with endoscopically and fluoroscopically placed Leonard long intestinal tube decompression. Most patients (59%) had failed a trial of nasogastric tube or Miller-Abbott tube decompression. Overall, 29 per cent of patients were able to resolve their obstruction with Leonard tube decompression alone. Subdivision of patients on the basis of the etiology of their obstruction demonstrated a much higher rate of success for tube decompression in adhesive obstruction (37%) versus malignant obstruction (12%) or inflammatory obstruction (no successes). Patients with radiographic and clinical evidence of complete intestinal obstruction were significantly less likely to respond to long intestinal tube treatment (13%). The long intestinal tube was easily passed in all patients. There were no complications of the intubation procedure in our series, and the incidence of tube-related complications was four per cent. We conclude that an initial period of long intestinal tube decompression allows a significant percentage of patients with mechanical small-bowel obstruction to be treated nonoperatively, particularly if a partial obstruction from postoperative adhesions is present. Patients who have failed a trial of nasogastric tube decompression and are poor operative risks should also be considered for long intestinal tube placement.     

Stellenwert der intraluminalen Darmdekompression durch eine endoskopisch plazierte Dennis-Sonde in der Therapie des Ileus

For determination of the efficacy of intraluminal bowel decompression by an endoscopically placed Dennis tube, 174 patients with paralytic ileus or different kinds of partial small bowel obstruction were reviewed retrospectively. There were 66 cases (37.9%) of early post-operative ileus (A), 27 (15.5%) of late postoperative ileus (B), 38 (21.8%) of paralytic ileus (C), 31 (17.8%) with obstruction due to advanced intraabdominal tumors (D), and 12 (6.8%) of obstructive ileus caused by inflammatory stenosis of the small bowel in Crohn's disease (E). Successful endoscopic placement of the intestinal tube was achieved in 97.2% of patients. Placement of the tube was impossible in 5 cases. A total of 95 patients (54.6%) were successfully managed by long intestinal tube decompression. Success rates for the individual groups were 71.2% (A), 18.5% (B), 86.8% (C), 16.1% (D), and 41.7% (E). Some 75 patients (43.1%) had to be operated on because of insufficient conservative therapy. Four patients with advanced intraabdominal tumors died during the treatment with the intestinal tube; 13 patients died postoperatively. There was no tube-related mortality, but tube-related complications occurred in 6.9%. We conclude that intraluminal intestinal tube decompression after endoscopic placement provides a therapeutic tool with a concomitant low complication and high success rate in paralytic and early postoperative ileus.     

合并布-加氏综合征的原发性肝癌的外科治疗

目的探讨合并布-加氏综合征的原发性肝癌的临床特征及治疗方法的选择。方法回顾性分析我科9例合并布-加氏综合征的原发性肝癌患者资料,分析临床特点及治疗方式的选择和预后。结果 9例患者中8例行肝癌切除治疗联合下腔静脉破膜球囊扩张或支架植入,1例既往2年前行BCS介入治疗后再发HCC行肿瘤切除,术后下肢水肿消失,曲张静脉好转,溃疡愈合,随访至今,无一例死亡,6例下腔静脉通畅,1例患者术后半年出现下腔静脉再次闭锁,行第二次下腔静脉球囊扩张支架植入治疗,1例术后12月肿瘤复发行TACE治疗。结论有效缓解症状,延长病人生存期,是临床治疗的理想选择,值得临床推广应用。     

择期腹腔镜手术治疗术后非绞窄性粘连性肠梗阻(附26例报告)

【摘要】 目的 探讨择期腹腔镜手术治疗术后非绞窄性粘连性肠梗阻临床应用及效果。 方法 2010年1月至2014年10月期间我院26例反复发作非绞窄性术后粘连性肠梗阻患者,急性发作经保守治疗缓解3个月后,择期采用腹腔镜手术治疗,术后早期下床活动,中药及物理治疗、液体治疗,观察术后疗效。结果 26例患者腹腔镜下成功完成手术治疗,术后7~15天(9.76±2.42天)康复出院,术后随访12~60个月(34.04±12.05月),术后未再出现肠梗阻临床表现。结论 择期选用腹腔镜手术是治疗术后非绞窄性粘连性肠梗阻的一种有效治疗方法。     

内镜下经鼻型肠梗阻导管在粘连性肠梗阻中的应用

目的探讨内镜下经鼻型肠梗阻导管在治疗粘连性肠梗阻中的应用价值。 方法回顾性分析2012年9月至2013年9月吉林大学中日联谊医院收治的粘连性肠梗阻患者30例,其中15例在术前行肠梗阻导管肠减压治疗,术中行肠梗阻导管小肠内支架排列,作为观察组;另外15例术前行胃肠减压治疗,术中未进行肠排列,仅应用防粘连材料,作为对照组。分别对比两组患者的手术时间、术中出血量、术后排气时间、术后住院时间、术后再次出现肠梗阻的概率等,观察其临床疗效。 结果观察组的术后排气时间(1.52 ± 0.87)d,术后2年内复发概率6.7%;对照组的术后排气时间(2.63 ± 0.59)d,术后2年内复发概率40.0%。两组患者在手术时间、术中出血量、术后住院时间比较,差异无统计学意义(P > 0.05),但是在术后排气时间及术后2年内复发概率上,观察组明显优于对照组[(1.52 ± 0.87)d vs (2.63 ± 0.59) d (P＝0.013)、1例 vs 6例(P＝0.001)]。 结论肠梗阻导管肠排列能有效的促进术后肠道功能的恢复,并预防粘连性肠梗阻的复发。     

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??Experience of retrograde long intestinal tube splinting for preventing postoperative adhesive small bowel obstruction: A study of 239 patients LI Min, REN Jian-an, ZHU Wei-ming, et al. Research Institute of General Surgery??Nanjing University School of Medicine??Nanjing General Hospital of Nanjing Military Command of PLA??Nanjing 210002??China
Corresponding author?? LI Ning??E-mail??liningrigs@vip.sina.com
Abstract Objective To study long intestinal tube splinting in the prevention of postoperative adhesive small bowel obstruction. Methods The clinical data of patients performed long intestinal tube splinting between December 2001 and December 2008 in Nanjing General Hospital of Nanjing Military Command of PLA were analyzed retrospectively. Medical records were reviewed in detail. The incidence of postoperative ASBO was obtained by follow-up. Results There were 239 patients received retrograde tube splinting. The tube related complication rate was 0.84??. After a median follow-up of (78.6±25.3) months, the incidence of postoperative ASBO was 5.04%. Conclusion The retrograde tube splinting has a lower tube-related complication rate?? It's an effective method to prevent recurrent ASBO.     

粘连性肠梗阻54例手术治疗体会

目的 探讨粘连性肠梗阻的手术指征和手术时机.方法 回顾性分析我院2002年9月～2006年9月手术治疗粘连性肠梗阻54例的临床资料.结果 本组54例全部治愈出院.术后发生伤口感染3例,术后5～7d再次出现梗阻者2例,均经保守治疗缓解.结论 急性粘连性肠梗阻的最佳手术时机应在肠绞窄发生之前.应用腹腔镜技术则手术指征可适度放宽.