成人粪石性急性小肠梗阻患者的早期诊治15例  

Early diagnosis and management of acute small intestinal obstruction due to bezoars in adults: an analysis of 15 cases

作　　者：陈庆永[1] 方志[1] 王春友[2] 

机构地区：[1]华中科技大学同济医学院附属协和医院急诊外科,湖北省武汉市430022 [2]华中科技大学同济医学院附属协和医院普外科,湖北省武汉市430022

出　　处：《世界华人消化杂志》2008年第25期2903-2905,共3页World Chinese Journal of Digestology

摘　　要：目的:总结无胃手术史成人粪石性急性机械性小肠梗阻患者15例诊治经验.方法:2003-04/2008-04我院共收治成人粪石性急性机械性小肠梗阻患者15例,均无胃大部切除术史.所有患者行腹部平片检查和腹部CT扫描,并先予以保守治疗,2例老年人不能耐受手术,以内服发泡剂或纤维素酶治疗后缓解;保守治疗3d后若肠梗阻症状无好转或逐渐加重后行手术治疗,11例行剖腹探查,2例行腹腔镜手术.结果:腹部平片检查均有大小不等的气液平面.腹部CT扫描均显示有肠内高密度粪石影.12例患者的粪石位于回肠,3例位于空肠.粪石的平均短轴直经是3.4cm,平均长轴直经是5.1cm.11例为单发粪石,占73.3%,4例为多发粪石,占36.7%.患者全部治愈,无并发症.结论:粪石性小肠梗阻多发于远端空肠和回肠,腹腔镜手术较传统开腹手术具有住院时间短、疼痛轻的优势.AIM： To present our experiences in treating acute small intestinal obstruction due to bezoars （ASIOB） in adults without a history of gastric surgery. METHODS： Fifteen adult ASIOB patients without a history of gastric surgery were treated in our hospital from April 2003 to April 2008. Abdominal X-ray and computed tomography （CT） scan were performed in all the patients, and conservative treatment was firstly used. Two-old patients who could not endure operation were treated with foaming agent or cellulose. Laparotomy was performed in 11 of 15 cases as conservative treatment was not effective after 3 days. Another 2 cases were treated by laparoscopic operation. RESULTS： Abdominal X-ray and CT scan showed air-fluid levels and presence of intraluminal hyperdense ＂stones＂, respectively. In 12 patients, bezoars were localized in the ileum, and in the rest 3 patients, they were found in the jejunum. The mean short-axis and long-axis diameters of the bezoars were 3.4 cm and 5.1 cm, respectively. Single bezoar was observed in 11 （73.3%） patients, and multiple bezoars were found in 4 （36.7%） cases. All of the 15 patients were cured without complications. CONCLUSION： Bezoars-induced small bowel obstruction frequently occurs in distal jejunum and ileum in adults. Laparoscopic operation is safe and effective in treating this disease with advantages of shorter hospital stay and lighter pain.

关 键 词：粪石 肠梗阻 腹腔镜 诊断 治疗 

分 类 号：R656.7[医药卫生—外科学]