肠腔内型机械性小肠梗阻13例的诊断和治疗体会  

Experience of diagnosis and treatment of 13 cases of intraluminal mechanical small bowel obstruction

作　　者：汪栋[1] 张文尧 宋建宁[1] 杨鋆 吴国聪[1] 李俊[1] WANG Dong;ZHANG Wen-yao;SONG Jian-ning(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Disease,Clinical Center for Colorectal Cancer,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科,国家消化系统疾病临床研究中心结直肠肿瘤临床诊疗与研究中心,北京100050

出　　处：《临床和实验医学杂志》2024年第10期1060-1064,共5页Journal of Clinical and Experimental Medicine

基　　金：国家重点研发计划资助(编号:2017YFC0110904);首都医科大学附属北京友谊医院科研启动基金资助项目(编号:yyqdkt2019-23);首都医科大学2023教育教学改革研究课题(编号:2023JYY159);首都医科大学结直肠肿瘤临床诊疗与研究中心(编号:1192070313)。

摘　　要：目的探讨肠腔内型机械性小肠梗阻的诊断和治疗体会。方法采用回顾性、描述性的研究方法。收集2016年10月至2022年5月首都医科大学附属北京友谊医院普通外科收治的13例肠腔内型机械性小肠梗阻的完整临床资料。所有患者术前均有不同程度的“痛、吐、胀、闭”等肠梗阻症状,术前均行急诊全腹CT平扫,并经过手术验证诊断。结果将13例肠腔内型机械性小肠梗阻分为4种病因:胆石性3例、非食源性异物1例、食源性粪石8例、血块性1例。胆石性组梗阻3例,均有胆囊结石病史且有典型的肠梗阻症状,全腹CT平扫提示Rigler三联征;3例患者均在急诊手术将梗阻远端约5~10 cm正常小肠对系膜缘纵行切开,将胆石挤向远端取出、近端肠管减压术。非食源性异物梗阻1例,有吞服胶囊内镜检查病史,术前出现肠梗阻症状;全腹CT平扫提示:小肠可见极高密度影(金属),近端肠管明显扩张、积液;术中将梗阻远端约10 cm正常回肠对系膜缘纵行切开,将异物挤向远端取出,近端肠管减压术。食源性粪石梗阻8例,有多次空腹食用“生柿子、生山楂、生李子或芒果”病史,术前出现肠梗阻症状;全腹CT平扫提示小肠病变完全充填梗阻节段肠腔,致使肠腔明显扩张;病灶密度均为夹杂气泡的“蜂窝状”或“筛孔状”,边界清楚有包壁征;术中将梗阻远端约10 cm正常小肠对系膜缘纵行切开,将粪石挤向远端取出,近端肠管减压术。血块性梗阻1例,患者有食用“生山楂”病史,术前出现肠梗阻症状;CT平扫提示肠道内多发小肠残渣征表现,故临床上误诊为“粪石梗阻”伴严重感染(白细胞快速异常增高)而行手术治疗,术中未发现明确机械性肠梗阻;术后胃镜提示胃贲门撕裂伤、活动性出血,予钛夹止血。结论肠腔内型机械性小肠梗阻病因繁杂,容易造成误诊,在临床实践中应该重视病史、查体,尤其是腹部CT扫描Objective To explore the experience of diagnosis and treatment of intraluminal mechanical small bowel obstruction.Methods Retrospective and descriptive research methods were used.The clinical data of 13 cases of mechanical intestinal obstruction in the general surgery department of Beijing Friendship Hospital,Capital Medical University from October 2016 to May 2022 were collected.All patients had different degrees of intestinal obstruction symptoms such as"pain,vomiting,distension and stop of exhaust and defecation"before operation.All patients underwent emergency abdominal CT scan before operation,and the diagnosis was verified by operation.Results The 13 cases were divided into four causes:cholelithiasis in 3 cases,non-food borne foreign body in 1 case,food borne fecal stone in 8 cases and blood clot in 1 case.In the cholelithiasis group,3 cases had a history of gallstone and typical symptoms of intestinal obstruction,and the abdominal CT scan showed Rigler's triad;in the emergency operation,the normal small intestine about 10 cm from the distal end of the obstruction was longitudinally cut through the mesenteric margin,and the gallstone was squeezed out to the distal end,and the proximal intestinal decompression was performed.One case of non-food borne foreign body obstruction had a history of swallowing capsule endoscopy,and presented with symptoms of intestinal obstruction before operation;the abdominal CT scan showed that high density shadow(metal)could be seen in the small intestine,and the proximal intestinal tube was obviously dilated and effused;during the operation,the normal ileum about 10 cm away from the distal obstruction was longitudinally cut to the mesenteric margin,and the hard material was squeezed out to the distal end,and the proximal intestinal tube was decompressed.There were 8 cases of food borne fecal stone obstruction.They had a history of eating"fresh persimmon,hawthorn or plum"on an empty stomach for many times,and had symptoms of intestinal obstruction before operation.The abdominal

关 键 词：小肠梗阻 肠腔内型小肠梗阻 机械性小肠梗阻 CT扫描 

分 类 号：R656.7[医药卫生—外科学]