X线透视下经肛肠梗阻导管置入桥接腹腔镜手术治疗乙状结肠扭转  

Fluoroscopy-guided placement of transanal decompression tube as a bridge measure in laparoscopic surgery of sigmoid volvulus

作　　者：郭永团[1] 李德春[1] 王光明[1] 权斌[2] 杜洪涛[1] GUO Yongtuan;LI Dechun;WANG Guangming;QUAN Bin;DU Hongtao(Department of Radiology,Xuzhou Municipal Central Hospital,Xuzhou,Jiangsu Province 221009,China)

机构地区：[1]徐州市中心医院放射科,江苏徐州221009 [2]徐州市中心医院胃肠外科,江苏徐州221009

出　　处：《介入放射学杂志》2024年第11期1208-1211,共4页Journal of Interventional Radiology

基　　金：江苏省徐州市卫生健康委医学科技创新项目(XWKYHT20230026)。

摘　　要：目的探讨X线透视下经肛肠梗阻导管置入桥接腹腔镜手术在乙状结肠扭转患者中的应用价值。方法回顾性分析徐州市中心医院2014年1月至2023年10月收治的21例未发生肠坏死的乙状结肠扭转患者资料。先行X线透视下肠梗阻导管置入治疗,症状消失后行腹腔镜下乙状结肠切除手术。统计介入操作成功率、介入操作时间、24 h临床症状缓解率、介入并发症发生率、中转急诊外科手术率、置管至腹腔镜手术时间,术中肠道情况,术后吻合口瘘、吻合口感染发生率,围手术期病死率。结果21例患者介入操作成功率100%,介入操作时间(9.9±2.5)min,24 h肠扭转症状缓解率100%,21例患者均未出现肠穿孔、肠出血等介入操作并发症,无一例中转外科急诊手术,置管至腹腔镜手术间隔(9.0±2.8)d,术中乙状结肠扭转均已复位,肠壁均无明显充血、水肿,术后1例患者出现吻合口感染,对症处理后痊愈,均未发生吻合口瘘,围手术期无死亡病例发生。结论X线透视下肠梗阻导管置入治疗乙状结肠扭转介入操作简单、安全、有效,将急诊手术转为择期腹腔镜乙状结肠切除一期肠吻合手术,术后并发症发生率、围手术期病死率低。Objective To investigate the application value of fluoroscopy-guided placement of transanal decompression tube as a bridge measure in laparoscopic surgery of sigmoid volvulus.MethodsThe data of 21 patients with sigmoid volvulus without intestinal necrosis,who were admitted to the Xuzhou Municipal Central Hospital of China from January 2014 to October 2023,were retrospectively analyzed.The patients received fluoroscopy-guided placement of transanal decompression tube first.After the clinical symptoms disappeared,laparoscopic sigmoid resection was carried out.The success rate of interventional operation,time spent for interventional procedure,postoperative 24-hour remission rate of clinical symptoms,incidence of interventional complications,frequency of transferring to emergency surgery,time from tube placement to laparoscopic surgery,intraoperative intestinal conditions,incidence of postoperative anastomotic fistula and anastomotic infection,and perioperative mortality were calculated.Results The success rate of interventional operation in 21 patients was 100%,the mean time spent for interventional procedure was(9.9±2.5)min,and the postoperative 24-hour remission rate of clinical symptoms was 100%.No interventional complications such as intestinal perforation or intestinal bleeding occurred in all the 21 patients.None of the patients was transferred to emergency surgery.The mean time from tube placement to laparoscopic surgery was(9.0±2.8)days.During the operation,the restoration of sigmoid volvulus was accomplished in all patients.No obvious congestion or oedema of the intestinal wall was observed.Postoperative anastomotic infection occurred in one patient,which was cured after symptomatic treatment,and no anastomotic fistula occurred in all patients.No perioperative death occurred.Conclusion For the treatment of sigmoid volvulus,fluoroscopy-guided placement of transanal decompression tube is technically-simple,clinically safe and effective,and the emergency surgery can be replaced by selective laparoscopic sig

关 键 词：乙状结肠扭转 介入放射学 腹腔镜 

分 类 号：R574[医药卫生—消化系统]