改良肠梗阻导管技术在难治性粘连性肠梗阻的临床应用  

Clinical application of improved transnasal ileus tube implantation technique in treating intractable adhesive small bowel obstruction

作　　者：李二生[1] 穆吉兴 孟庆聚 徐兰斌 于华[1] 李晓敏 聂红峰 王建忠[1] 张春山 李强 李晓军 LI Ersheng;MU Jixing;MENG Qingju;XU Lanbin;YU Hua;LI Xiaomin;NIE Hongfeng;WANG Jianzhong;ZHANG Chunshan;LI Qiang;LI Xiaojun.(Department of Radiology, First Affiliated Hospital, Xingtai Medical College, Xingtai, Hebei Province 054001, China)

机构地区：[1]邢台医学高等专科学校第一附属医院放射科,河北054001

出　　处：《介入放射学杂志》2018年第7期645-650,共6页Journal of Interventional Radiology

摘　　要：目的评价改良肠梗阻导管技术在难治性粘连性肠梗阻的临床应用。方法 2012年2月至2017年6月对54例难治性粘连性肠梗阻患者采用改良肠梗阻导管技术治疗并进行随访。改良肠梗阻导管技术是采用球囊接力的方式通过肠梗阻的阻塞段和采用反复回拉肠梗阻导管的方式疏通粘连的肠道。术后第1,3,6个月及之后每半年进行随访并收集相关的临床和影像数据。结果 54例患者肠梗阻导管均成功放置,放置深度为越过屈氏韧带20 cm以上。54例中47例肠梗阻导管成功通过阻塞段进入结肠内,梗阻段通过率为87.0%。拔管后50例患者的肠梗阻症状及体征完全消失,4例患者由于小肠重度梗阻,导管无法缓解肠梗阻症状,遂行外科肠粘连松解术。影像随访3～38个月,造影复查显示48例对比剂进过小肠通畅,未见明显肠梗阻现象。临床随访6～45个月,2例肿瘤术后患者再发现肠梗阻表现。54例中6例患者在术后8～15个月死于肿瘤复发所致的全身衰竭;48例患者的肠梗阻症状和体征完全消失,无肠梗阻症状复发。结论改良肠梗阻导管技术是一种简单和有效的治疗难治性粘连性肠梗阻的方法。Objective To discuss the clinical application of improved transnasal ileus tube implantation technique in treating intractable adhesive small bowel obstruction （ASBO）. Methods From February 2010 to June 2017 improved transnasal ileus tube implantation technique was employed in 54 patients with intractable ASBO, and all the patients were clinically followed up. The operational process of improved transnasal ileus tube implantation technique was as follows： using the way of balloon relay to make the ileus tube passing through the obstructed intestinal segment and using the way of repeatedly pulling the ileus tube back and forth to dredge the adhesive intestine. The patients were followed up at one, 3, 6 months and thereafter once every six months after the treatment to collect relevant clinical and imaging information. Results Successful implantation of ileus tube was accomplished in all 54 patients. The tip of the implanted tube was inserted across over Treitz ligament more than 20 era. Except 7 patients, in other 47 patients the ileus tube successfully passed through the obstructed intestinal segment and entered the colon, the passing rate of obstructed segment was 87.0%. After retrieval of the tube, the symptoms and signs of intestinal obstruction disappeared completely in 50 patients, in other 4 patients the intestinal obstruction symptoms could not be relieved as the intestinal obstruction was very severe and surgical enterodialysis had to be earried out. The patients were followed up with imaging examinations for 3-38 months. Radiographic examination showed that the contrast media smoothly passed through the small intestine in 48 patients, and no obvioussigns of intestinal obstruction were observed. During clinical follow-up period lasting for 6-45 months, 2 patients developed intestinal obstruction again after surgery of tumors, 6 patients died of systemic failure due to recurrence of tumor in 8-15 months after treatment, and other 48 patients had no clinical symptoms and signs of intestinal obstructio

关 键 词：小肠梗阻 肠梗阻导管 粘连 回拉 

分 类 号：R656[医药卫生—外科学]