经肠镜减压术在全膀胱根治性切除+Bricker术后假性结肠梗阻中的应用  

The application of colonoscopic decompression in the pseudo bowel obstruction after radical bladder resection and Bricker

作　　者：金鑫[1] 许传亮[2] 张振生[2] 王辉清[2] 杨波[2] 牛天力[1] 郑明华[1] 赵文超[1] 

机构地区：[1]南通大学附属泰州市人民医院泌尿外科,江苏泰州225300 [2]第二军医大学附属上海长海医院泌尿外科,上海200433

出　　处：《中国内镜杂志》2013年第12期1330-1332,共3页China Journal of Endoscopy

摘　　要：目的初步评价经肠镜减压术在全膀胱根治性切除＋Bricker术后假性结肠梗阻中的应用价值。方法 2006年11月~2011年4月6例全膀胱根治性切除＋Bricker术后假性结肠梗阻保守治疗3 d以上无效患者行肠镜减压术。术中缓慢循腔进镜,镜头位于肠腔中部,并尽量减少镜头接触肠壁,进镜约5 cm左右抽吸一次,少注气或不注气。视野欠清以温开水冲洗,冲洗量约50 mL,冲后立即吸出。结果 6例患者均获成功,其中1例行2次肠镜减压。术中可见结肠腔内有大量粪水及气体,黏膜充血、水肿、血管纹理欠清,肠蠕动波少,肠壁张力增高。吸出肠腔内的气体及粪水后,患者腹痛、腹胀明显缓解。减压术后3 d平均24 h尿量较术前3 d明显增加（[3 520±280）mL vs（1 150±230）mL,P〈0.01];术后肠鸣音恢复正常时间30~72 h;7例次患者减压术后3 d腹围较减压术前明显减少（[83±4）cm vs（92±5）cm,P〈0.05];术后5 d腹部平片较减压术前明显好转。结论经肠镜减压术治疗全膀胱根治性切除＋Bricker术后假性结肠梗阻是有效的,安全的。【Objective】 To evaluate the application of colonoscopic decompression in the pseudo bowel obstruction after radical bladder resection ＋ Bricker. 【Methods】From November 2006 to April 2011, six patients with pseudo bowel obstruction after radical bladder resection ＋ Bricker received colonoscopic decompression after invalid of conservative treatment for 3 days. Colonoscopic was slowly put into the intestine with the lens in the middle and minimized contact with the intestine wall, suctioned immediately after a small gas injection or some washing water with each about 5cm forward.【Results】6 patients successfully received colonoscopic decompression,one patient received one time again. colonoscopy found a large number of manure and gas in the intestine, mucosal congestion, edema, vascular texture less clear, less wave peristalsis, and the intestinal wall tension increased. Sucked gas and manure, the abdominal pain and abdominal distension were relieved. Compared with 3 days ago after decompression, the 24 h urine volume increased significantly [（3520 ± 280） mL vs（1150 ± 230） mL]. Bowel sounds resumed 30-72 h. compared with 3 days ago, the abdominal circumference was significantly reduced [（83 ± 4） cm vs（92 ± 5） cm]： after 5d KUB significantly improved compared with preoperative surgery, the KUB showed the symptom significantly improved. 【Conclusions】Colonoscopic decompression for treatment of patients with pseudo bowel obstruction is effective and safe after radical bladder resection ＋ Bricker.

关 键 词：假性结肠梗阻 经结肠减压术 全膀胱根治性切除 

分 类 号：R616.2[医药卫生—外科学]