肠梗阻导管置入联合肠切除术治疗老年急性乙状结肠扭转的可行性及疗效  

Endoscopic catheterization of ileus tube combined enterectomy for the treatment of elderly patients with acute sigmoid volvulus:feasibility and efficacy

作　　者：董江楠 傅代全 朱庆云[1] 陈石伟 乔德林 李军[1] 刘江齐 蔡晓燕 

机构地区：[1]第二军医大学附属浦东新区公利医院普外科,上海市200135 [2]第二军医大学附属浦东新区公利医院介入科,上海市200135

出　　处：《实用医学杂志》2017年第24期4097-4101,共5页The Journal of Practical Medicine

基　　金：浦东新区卫计委项目(编号:PW2014A-32);上海浦东新区公利医院领军人才计划(编号:GLRl2017-01)

摘　　要：目的分析经肛肠梗阻导管置入联合肠切除术治疗老年急性乙状结肠扭转的可行性及疗效。方法自2015年8月至2017年8月,上海浦东新区公利医院收治的27例老年急性乙状结肠扭转患者接受了肠镜下经肛肠梗阻导管置入联合肠切除术。回顾性收集患者置管前后和肠切除术的临床数据及术后随访资料,计算置管成功率、肠道减压有效率、手术成功率、术后并发症发生率及联合治疗有效率。结果 27例(100%)患者均成功置入肠梗阻导管;其中1例因肠管坏疽接受急诊手术,余26例置管后血象及内环境紊乱均明显好转,置管减压有效率96.3%。全组肠切除术成功率100%,术后严重并发症发生率22.2%,围手术期病死率3.7%。术后随访期间,2例(7.4%)再发肠梗阻,联合治疗有效率85.2%。结论经肛肠梗阻导管置入可有效降低老年急性结肠扭转患者的肠道压力,肠道准备和改善内环境后降低了术后死亡率。肠镜下肠梗阻导管置入联合肠切除术是安全、有效的联合治疗方式。Objective To investigate the feasibility and efficacy of endoscopic catheterization of ileus tube combined enterectomy for the treatment of elderly patients with acute sigmoid volvulus. Methods From August 2015 to August 2017,27 cases of elderly patients with acute sigmoid volvulus received treatment of endoscopic placement of ileus tube combined enterectomy in Pudong New Area Gongli Hospital.Retrospectively collected clin-ic parameters of pre-catheterization,post-catheterization,enterectomy and postoperative follow-up;the success rate of catheterization and enterectomy,compression efficiency,post-operative complications,and efficacy of the com-bined therapy were analyzed. Results Emergency catheterizations of anorectal ileus tube were succeeded in 27 （100%）patients;one patient who developed intestinal gangrene received emergency enterectomy,the hemogram and internal environmental disturbance of the 26 cases were significantly relieved,and the efficacy rate of decom-pression was 96.3%. The success rate of was enterectomy was 100%;the incidence of severe complications and mortality were 22.2% and 3.7%,respectively. During the follow-up,2（7.4%）patients developed ileus,and the efficacy rate of the combined therapy was 85.2%. Conclusions The catheterization of ileus tube could effectively depress intestinal pressure. The success rate of enterectomy was significantly improved and postoperative mortality was reduced. The therapy of endoscopic ileus tube catheterization combined enterectomy is a safe and effective method for the treatment of acute sigmoid volvulus in the elderly.

关 键 词：肠扭转 肠梗阻 内镜下治疗 肠梗阻导管 肠切除术 

分 类 号：R656.9[医药卫生—外科学]