经鼻超细胃镜辅助下肠梗阻导管置入治疗老年人粘连性肠梗阻的疗效观察  

Efficacy of transnasal ultra-thin gastroscope-assisted ileus tube placement for the treatment of adhesive intestinal obstruction in the elderly

作　　者：房龙[1] 陶永康[1] 杜时雨[1] Fang Long;Tao Yongkang;Du Shiyu(Department of Gastroenterology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院消化内科,北京100029

出　　处：《中华老年医学杂志》2023年第8期936-940,共5页Chinese Journal of Geriatrics

基　　金：北京市自然科学基金资助项目(7204303)。

摘　　要：目的为评价经鼻超细胃镜辅助下肠梗阻导管置入治疗老年人粘连性肠梗阻的可行性及疗效。方法随机对照试验,共纳入老年粘连性肠梗阻患者81例,按照计算机生成随机数字分为经鼻超细胃镜肠梗阻导管置入组46例(观察组)、经口普通胃镜肠梗阻导管置入组35例(对照组)。采用肠梗阻导管组套进行操作,比较记录两组肠梗阻导管置入时间,置管过程是否有口鼻出血、呕吐等症状,置管成功率,症状缓解情况,影像学缓解情况。结果双观察组3d内症状缓解率为93.5%(43/46)、对照组为88.6%(31/35),影像学缓解率观察组为82.6%(38/46)、对照组为74.3%(26/35),两组患者3d内症状缓解与3d影像学缓解方面差异均无统计学意义(X^(2)值分别为0.144、0.830,均P0.05)。观察组的置管操作时间为(15.4±4.2)min,短于对照组(21.3±3.1)min(t=6.984,P<0.01);且两组置管成功率均为100%,两组所有患者均置管成功。不良反应方面,观察组鼻出血、恶心呕吐、咽痛的发生例数分别为1例、2例、1例,总不良反应发生率为8.7%(4/46);对照组分别为0例、18例、4例,总不良反应发生率为62.9%(22/35);两组患者鼻出血(Fisher精确概率P=0.568)、咽痛(X^(2)=1.559、P=0.212)的发生率差异均无统计学意义,但恶心呕吐以及总不良反应发生率差异均有统计学意义(X^(2)值分别为23.694、26.752,均P<0.01)。结论经鼻超细胃镜辅助置入肠梗阻导管可减少患者置管时恶心呕吐等不适,操作时间短,具有较高的成功率,尤其对老年患者具有较好的临床应用价值。Objective To assess the feasibility and effectiveness of transnasal ultra-thin gastrointestinal endoscope-guided ileus tube insertion for the treatment of adhesive intestinal obstruction in the elderly.Methods Randomized controlled trial,a total of 81 elderly patients with adhesive intestinal obstruction were enrolled,with 46 receiving transnasal ultra-thin gastroscope-assisted tube placement(observation group)and 35 receiving conventional transoral gastroscope-assisted tube placement(control group).Tube insertion was carried out.Data on the time needed for tube placement,incidents of oral or nasal bleeding,rates of successful tube placement,physical signs of symptom relief and imaging signs of symptom relief were recorded and compared between the two groups.Results The symptom remission rate within 3 d was 93.5%(43/46)in the observation group and 88.6%(31/35)in the control group,and the rate for imaging signs of symptom remission was 82.6%(38/46)in the observation group and 74.3%(26/35)in the control group.The differences in symptom remission and imaging signs of symptom remission within 3 d were not statistically significant between the two groups(X^(2)=0.144,0.830,all P>0.05).In the observation group,the time needed for tube placement was(15.4±4.2)min,which was significantly shorter than that in the control group(21.3±3.1)min(t=6.984,P<0.01).The rate of successful tube placement was 100%in both groups.In terms of adverse reactions,the observation group had 1 patient with nasal bleeding,2 with nausea and vomiting,and 1 with a sore throat,with an overall adverse reaction rate of 8.7%(4/46),while the control group had no patient with bleeding,18 with nausea and vomiting,and 4 with a sore throat,with an overall adverse reaction rate of 62.9%(22/35).There was no statistically significant difference in nasal bleeding(Fisher's exact probability P=0.568)or a sore throat(X^(2)=1.559,P=0.212),but the differences in the incidence of nausea and vomiting as well as the incidence of total adverse reactions were statistica

关 键 词：肠梗阻 导管插入术 胃镜 

分 类 号：R574.2[医药卫生—消化系统]