从1例食管-胃瘘患者的救治浅谈小承气汤在术后肠道功能恢复中的治疗体会  

Treatment experience in the application of Xiaochengqi decoction improving gastrointestinal function from 1 case report of esophagogastric fistula

作　　者：李元英 顾春林[1] 李峻[1] Li Yuanying;Gu Chunling;Li Jun(Department of General Surgery,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京中医药大学附属医院普外科,江苏南京210029

出　　处：《中国中西医结合急救杂志》2023年第5期621-623,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：江苏省中医药科技发展计划项目(ZD201903)。

摘　　要：目的分析促使术后消化道瘘相关胃肠功能恢复的原因及小承气汤鼻饲与灌肠给药对胃肠功能恢复的作用.方法回顾性分析2022年3月16日南京中医药大学附属医院收治的1例胃间质瘤术后并发吻合口瘘患者的临床资料,观察中药对术后胃肠功能恢复的影响.结果患者男性,77岁,因贲门肿瘤于2022年3月16日行腹腔镜近端胃切除、食管-远端胃吻合术.术后期7d,腹腔引流管出现少许浑浊物,消化道造影后出现上腹部剧烈疼痛,提示吻合口瘘.经小承气汤灌胃加鼻饲,瘘后15d恢复通气,并解出大量黑糊状大便;瘘后21 d,鼻肠管鼻饲补中益气汤合小承气汤;瘘后47 d,可下床站立,继续中药灌肠后解大便;术后58d行消化道造影示:原瘘口处无造影剂溢出,造影剂可顺利通过十二指肠.食管下端吻合口狭窄.拔除胃管、鼻肠管,流质饮食,自行解成形大便,无腹胀腹痛;术后63d出院.结论采用中药小承气汤灌肠配合鼻饲能有效恢复胃肠道功能,缩短排气排便时间,加速胃肠道功能恢复,改善全身状况,促进疾病痊愈.Objective To analyze the reasons of gastrointestinal function recovery related to postoperative esophagogastric fistula and the roles of the Xiaochengqi decoction by enema and jejunal nutrition tube on gastrointestinal function recovery.Method Clinical data of 1 patient with esophagogastric anastomotic fistula after gastric stromal tumors(GST)resection on March 16,2022 was retrospectively analyzed,to observe the influence of Traditional Chinse Medicine in postoperative recovery.Results The patient,a 77-year-old male,underwent laparoscopic proximal gastrectomy and esophagogastrostomy on March 16,2022 due to cardia tumor.Seven days after surgery,there was some turbid matter in the abdominal drain tube,severe pain on upper abdomindal occurred after digestive tract radiography,it was indicated that anastomotic fistula was exsited.After intragastric administration and nasal feeding of Xiaochengqi decoction,anus ventilates and defecates much mushy stool on the 15th day after postoperative esophagogastric fistula.On the 21st day after fistula,Buzhongyiqi and Xiaochengqi decoction was applied by nasointestinal feeding tube.On the 47th day,the patient got out of bed and stood,the stools were out by enema.On the 58th day after surgery,the digestive tract radiography indicated there was not any contrast media overflow near the fistula and contrast media could get through the duodenum smoothly.Anastomotic stricture.After tube extraction,a liquid diet is fed,formed stool is defecated without abdominal distension and pain.On the 63rd day after surgery,the patient is discharged from hospital.Conclusions It is advantageous for the recovery of gastrointestinal function by enema and jejunal nutrition tube feeding of Xiaochengqi decoction.It shortens the anal exhaust time,fastens the recovery of gastrointestinal function,improves health status,promotes healing,and shortens the length of stay.

关 键 词：食管-胃瘘 术后 胃肠功能恢复 中医药疗法 小承气汤 灌肠 空肠营养管饲 

分 类 号：R656[医药卫生—外科学]