放射性肠炎并发急性肠梗阻的临床特点及治疗  

Clinical characteristics and management of radiation enteritis with acute intestinal obstruction

作　　者：刘亮[1] 张楠[1] 邹常林[1] 杨士民[1] 周振理[1] 

机构地区：[1]天津市南开医院胃肠外科,天津300100

出　　处：《中国普通外科杂志》2012年第10期1260-1265,共6页China Journal of General Surgery

摘　　要：目的：探讨放射性肠炎并发急性肠梗阻的临床特点和治疗方法。方法：对2006年10月-2011年3月收治的25例放射性肠炎并发急性肠梗阻病例的临床资料进行回顾性分析。结果：患者入院后均实施肠梗阻导管肠道减压及积极营养支持等非手术治疗，急症病情得到缓解后，经导管行选择性泛影葡胺小肠造影，显示梗阻部位的病理变化。全组24例接受了手术治疗，术中显示放射性损伤以盆腔和回肠为著，器官之间和肠袢之间界限不清，甚至相互融合形似冰冻状；13例行病变肠袢切除肠吻合术，10例行回肠-结肠短路吻合术，1例行右半结肠切除术，21例同时行小肠内置管排列术；1例行非手术治疗后梗阻解除。除1例肠切除患者术后因腹腔和肺部感染死亡外，全组96．O％（24／25）获得治愈。23例随访6—24个月，远期有效率为95．7％（22／23）。结论：放射性肠炎并发急性肠梗阻采用恰当的非手术治疗可将急症手术转变为限期或择期手术，病变肠袢切除或肠短路吻合术联合小肠内置管排列术是较好的手术方式。Objective： To analyze the clinical characteristics and treatment approaches of radiation enteritis with acute bowel obstruction. Methods： The clinical data of 25 patients with radiation enteritis complicated by acute bowel obstruction admitted from October 2006 to March 2011 were retrospectively analyzed. Results： All patients underwent conservative treatment such as catheter intestinal decompression and aggressive nutritional support, and once their emergency conditions were alleviated, selective gastrografin contrast examination of the small bowel was performed via the decompression catherer to reveal the pathologic changes causing obstruction. Of the entire group, 24 cases underwent surgical treatment. Intraoperative findings showed that most radiation injuries occurred in the pelvic cavity or ileum, and there were indistinct borders between intestinal loops as well as abdominal organs, which were even adhered together in a frozen- like state. Thirteen patients underwent resection of obstructing lesion with anastomosis, 10 patients underwent ileocolic bypass anastomosis, right hemicolectomy was performed in one patient, and small intestine intubation and plication techniques were synchronously used in 21 cases, qqae bowel obstruction was resolved in one patient with nonsurgical treatment. Except for one patient who died of intra-abdorninal and lung infection after surger）5 24 of 25 patients （96.0%） were cured. Twenty-three patients were followed up for 6 to 24 months, and the long-term efficacy rate was 95.7% （22/23）. Conclusion： Proper conservative treatment can change emergent operation to a scheduled or elective operation for radiation enteritis associated acute bowel obstruction. Resection of obstructing lesion with anastomosis or entero-enteric bypass anastomosis combined with small intestine intubation is the preferred procedure for surgical treatment of this condition.

关 键 词：肠梗阻/外科学 辐射损伤 放射性肠炎 

分 类 号：R656.7[医药卫生—外科学]