110例外科术后早期炎性肠梗阻临床研究

目的: 对外科术后早期炎性肠梗阻的诊治特点和原则进行相关探讨。方法: 分析我院2002年5月-2012年5月期间的110例外科术后早期炎性肠梗阻进行临床资料的分析。结果: 110例患者经过肠胃减压、生长抑素的应用、营养支持和肾上腺皮质激素的应用等治疗手段后都获得痊愈。结论: 术后5-7天比较容易发生早期炎性肠梗阻,多为腹腔内炎症导致的肠粘连引起,可以先实行相关的保守治疗,能获得很好的疗效。     

儿童术后早期炎性肠梗阻诊治探讨

目的:探讨儿童腹部手术后早期炎性肠梗阻的诊治方法.方法:对17例腹部手术后出现术后早期炎性肠梗阻的患儿采用禁食、胃肠减压、静脉营养支持、中药灌注、抗感染等综合治疗.结果:17例患儿均顺利恢复.炎性梗阻症状消失,院外随访未见不适.结论:采用非手术保守治疗儿童术后早期炎性肠梗阻是安全有效的.     

双歧杆菌三联活菌胶囊在术后早期炎性肠梗阻治疗中的应用

目的探究双歧杆菌三联活菌胶囊辅助治疗术后早期炎性肠梗阻的临床效果。方法收集兰州大学第一医院2014年9月至2016年9月收治的术后早期炎性肠梗阻患者56例为研究对象,随机分为对照组和干预组,每组28例,对照组予以常规治疗,干预组在对照组治疗基础上加用双歧杆菌三联活菌胶囊。收集整理两组患者临床数据并分析比较临床治疗效果。结果两组患者治疗总有效率差异无统计学意义(P0.05)。干预组患者腹胀消失时间、肛门排气时间、肠鸣音恢复时间均较对照组短(P0.05);两组患者治疗前后降钙素原下降及淋巴细胞绝对值增加差异均有统计学意义(P0.05),且干预组治疗前后降钙素原降低及淋巴细胞绝对值增加幅度与对照组相比差异均有统计学意义(P0.05)。结论双歧杆菌三联活菌胶囊用于术后早期炎性肠梗阻的治疗,可缩短治疗时间,促进肠道免疫功能恢复,且使用安全,值得临床推广。     

58例经鼻肠梗阻导管治疗非绞窄性小肠梗阻疗效观察

目的:探讨经鼻肠梗阻导管治疗非绞窄性小肠梗阻临床效果。方法:选择2013年3月至2014年5月我院普外科收治的58例非绞窄性小肠梗阻患者,根据治疗方法不同分成实验组(29例)与对照组(29例),实验组经鼻肠梗阻导管治疗,对照组经普通鼻胃管治疗,分析两组住院时间、住院费用、腹围及胃肠减压引流量等指标情况。结果:实验组腹围(77.9+6.1)cm、胃肠减压引流量(949.0+122.1)ml/d,明显优于对照组的腹围(89.7+5.6)cm、胃肠减压(417.2+98.5)ml/d,实验组住院时间(7.0+1.7)d、住院费用(14000.6+2278.1)元,明显优于对照组的住院时间(11.1+3.4)d、住院费用(19800.2+2970.3)元,两组差异明显(P0.05)。结论:对于非绞窄性小肠梗阻,经鼻肠梗阻导管治疗,可明确梗阻部位病及因,减少患者住院时间及住院费用,值得推广应用。     

小儿腹部手术后并发早期炎性肠梗阻的病情观察与护理

我科2005年6月～2011年1月发生术后早期炎性肠梗阻患儿16例,由于病情发现及时,治疗明确,护理措施得当,全部患儿均痊愈出院,现将护理体会介绍如下。     

31例颈静脉扩张症的诊治体会

目的:提高对颈静脉扩张症的认识,探讨临床诊断和治疗方法.方法:回顾性分析31例颈静脉扩张症的临床资料.经val-salva试验、彩色超声和放射影像学检查,确定颈静脉扩张症的病变性质、程度和范围.治疗措施包括病灶切除术(6例)、颈静脉纵向缩缝术(14例)、颈静脉成型术(6例)、保守治疗(4例),上纵隔肿瘤患者1例转胸外科治疗.结果:经手术治疗的患者.均痊愈出院,无术后并发症.除1例肿瘤患者以外,全组病例随访6～62个月,平均26.2个月,健康状况良好.结论:先天性静脉发育异常是颈静脉扩张症最常见的病因.颈静脉扩张可长期存在而无症状.对影响美容、有临床症状的患者,早期手术是消除症状、达到美容目的的有效的治疗方法.     

术前营养支持在慢性放射性肠炎合并肠梗阻临床手术中的应用效果

目的：探讨慢性放射性肠炎合并肠梗阻患者应用术前营养支持对手术效果的影响。方法：选择青岛市中心医院慢性放射性肠炎合并肠梗阻患者,根据患者是否接受术前营养支持分为观察组和对照组,探讨术前营养支持对患者营养指标、手术指标及术后恢复情况的影响。结果：与对照组相比,观察组患者手术时各项营养指标均有提升,前白蛋白、转铁蛋白和白蛋白水平显著优于入院时水平,术后总并发症发生率、造口率和住院时间亦优于对照组,差别均具有统计学意义（P＜005）;观察组组内比较,接受胃肠内营养支持或联合营养支持的患者总并发症发生率、造口率和住院时间明显低于全胃肠外营养者,差异明显（P＜005）。结论：将术前营养支持应用于慢性放射性肠炎合并肠梗阻患者临床治疗中,可提升患者营养状况、降低术后不良并发症、缩短住院时间,值得临床推广。     

腹腔镜探查并治疗腹部恶性肿瘤术后肠梗阻的临床研究

目的:探讨腹腔镜辅助探查并治疗腹部恶性肿瘤术后肠梗阻患者的可行性及安全性。方法:应用腹腔镜技术对我院42例腹部恶性肿瘤术后患者行手术治疗,其中包括良性粘连性肠梗阻14例、肿瘤复发16例、原发性结肠癌1例、恶性肠粘连11例。结果:42例患者均在腹腔镜下明确诊断,其中18例患者在完全腹腔镜下手术治疗,13例患者在腹腔镜辅助下行手术治疗,6例患者腹腔严重粘连中转开腹手术治疗,5例患者腹腔广泛转移行保守治疗。腹腔镜手术时间为35~290min,平均住院日9.2±1.7d。患者术后疼痛较轻、下床活动时间及肠道功能恢复时间短、术后并发症少。结论:恶性肿瘤术后肠梗阻患者仍需手术治疗,在严格掌握手术适应症下,应用腹腔镜技术对恶性肿瘤术后肠梗阻病人的治疗是安全、可行的。     

对阑尾炎周围脓肿的临床治疗的分析

目的:阑尾炎周围囊肿比较常见,且会给患者带来一定的痛苦,所以,本文将对其相关临床治疗方法展开分析,评价优劣,以便减轻患者痛苦,帮助患者的早日痊愈;方法:对100例该病患者施以相应治疗,并将之作为分析对象,先行保守治疗,当效果未达预期效果时,再改行手术治疗;结果:经保守治疗之后,有40例患者得以痊愈出院,另外,有60例患者改行手术治疗,也全部得以痊愈出院,100例患者均无并发症的出现;结论:对于该类患者而言,若保守治疗未达预期效果,建议立即改行手术治疗,这对于减轻患者痛苦,帮助患者早日痊愈而言具有相当积极的意义。     

梗阻性低位直肠癌保肛手术可行性探讨

目的:探讨梗阻性低位直肠癌保肛治疗(直肠癌前切除术(dixon手术))的可行性及术后肠瘘的防治。方法:回顾性分析我科2009年1月-2012年1月梗阻性低位直肠癌的保肛治疗(dixon)24例手术患者(梗阻性保肛组)临床资料及非梗阻性低位直肠癌保肛治疗(dixon)的24例患者(非梗阻性保肛组)临床资料,比较梗阻性与非梗阻性低位肠梗阻保肛治疗的临床疗效,分析梗阻性低位肠梗阻保肛治疗的可行性。结果:梗阻性保肛组住院天数:11.9天,非梗阻性肠梗阻保肛组8.7天P0.05;梗阻性保肛组发生肠瘘:4例(16.7%),非梗阻性肠梗阻保肛组发生肠瘘:1例(4.2%)P0.05,经充分引流后肠瘘愈合,无1人死亡,两组术后至出院期间死亡人数:0例;梗阻性保肛组肠功能恢复(以排气排便为指标):5.1天,非梗阻性保肛组肠功能恢复:3.8天,P0.05;术后6个月腹泻便秘患者两组相同为24人;术后6个月梗阻性保肛组肿瘤复发6人(25%),非梗阻性保肛组肿瘤复发5人(20.8%),P0.05。结论:梗阻性低位肠梗阻保肛治疗住院期疗效较非梗阻性保肛组差,中远期疗效无明显差异。梗阻性低位直肠癌可行保肛治疗。     

胃癌患者术后并发症的危险因素分析

目的:探讨胃癌术后并发症的危险因素及其防治措施.方法:调查117例胃癌患者手术治疗前后的临床资料,并对术后发生并发症可能的危险因素进行评估、分析.结果:胃癌术后并发症包括切口感染、肺部感染或胸腔积液、腹腔感染、肠梗阻、吻合口瘘,发生率为35.04％(41/117),手术方式、手术时间、胃管留置时间、术后生活习惯与手术后并发症相关(P＜0.05).结论:胃癌术后并发症由多种原因综合引起,除患者素质和病变因素外,6个危险因素依次为:行全胃切除、D2清扫、手术时间＞4h、术中出血量≥800mL、胃管留置时间＞3d、长期吸烟,应重视其围手术期处理.     

Clinical and Diagnostic Significance of Enteroclysis Through Nasointestinal Decompression Intubation

To study the clinical and diagnostic significance of enteroclysis through nasointestinal decompression intubation, thirty-five patients with small bowel obstruction were enrolled. A nasointestinal catheter of 300 cm was placed through the nasal cavity then pushed to the upper jejunum under X-ray realtime monitoring. The patients underwent intra-small-intestinal suction therapy reducing or relieving the obstruction after 3 days. As the catheter reached the lesions, we conducted selective imaging. Using fluoroscopy, we injected 20–100 ml meglumine diatrizoate 76 % and 50–200 ml air via the decompression suction port to produce a double-contrast radiography. The catheter was then retrieved to the upper jejunum, and the X-ray of the small intestine was obtained. All 35 patients had successful intubations. The decompression treatment resolved symptoms in 20 cases and alleviated symptoms in 15 cases. Ten cases underwent surgery. The images obtained by infusing meglumine diatrizoate through the decompression catheter were of good quality. Among the 35 cases, six were absent of any distinct abnormal signs on the X-ray, 15 had adhesive ileus, four had small bowel tumor (three metastatic tumor, one small bowel cancer), three had Crohn’s disease, three had radiation enteritis (one of the three was mistaken for small bowel metastatic tumor), two had enteric intussusception, one had a polyp in the small intestine, one had ascending colon cancer. The nasointestinal decompression intubation under X-ray monitoring serves a dual function for patients with intestine obstruction, by decompressing the small bowel and examining the small intestinal radiographically. The X-rays can confirm the obstruction and provide guidelines for surgery.     

INTESTINAL ADHESIONS-Present Status of Prevention and Treatment

Although many treatments have been proposed for the prevention of intestinal adhesions, none has been completely effective. For bowel obstruction due to adhesions the initial approach should be conservative. If operation becomes necessary, the best results depend on avoidance of trauma and infection, division of adhesions with cautery, use of mesothelial grafts, instillation of intraperitoneal hyaluronidase and stimulation of early postoperative peristalsis. In the event of massive adhesions or failure of other treatment, intestinal plication is the treatment of choice.     

INTESTINAL ADHESIONS—Present Status of Prevention and Treatment

Although many treatments have been proposed for the prevention of intestinal adhesions, none has been completely effective. For bowel obstruction due to adhesions the initial approach should be conservative. If operation becomes necessary, the best results depend on avoidance of trauma and infection, division of adhesions with cautery, use of mesothelial grafts, instillation of intraperitoneal hyaluronidase and stimulation of early postoperative peristalsis. In the event of massive adhesions or failure of other treatment, intestinal plication is the treatment of choice.     

MALFUNCTIONING POSTGASTRECTOMY STOMA—Diagnosis and Treatment

Individualization in the treatment of patients with malfunctioning gastrojejunostomy stomas is paramount. Prompt surgical intervention in critically ill patients is necessary to save life.In the early postoperative phase, the use of barium studies is disappointing and very seldom gives information as to the actual site of the obstruction.In surgical treatment, operation directly upon the stoma should be avoided as much as possible. The release of small bowel obstruction, the reduction of intussusception or the correction of retraction of the jejunum through the mesocolon can be accomplished readily. Double or single jejunostomy for feeding and decompression are all that is necessary in cases in which no cause can be found for obstruction at or below the stoma.In a patient with peptic ulcer, the use of enteroenterostomy below the stoma is unphysiological and will predispose to gastrojejunal ulcer at a later date.     

Malfunctioning postgastrectomy stoma; diagnosis and treatment

Individualization in the treatment of patients with malfunctioning gastrojejunostomy stomas is paramount. Prompt surgical intervention in critically ill patients is necessary to save life. In the early postoperative phase, the use of barium studies is disappointing and very seldom gives information as to the actual site of the obstruction. In surgical treatment, operation directly upon the stoma should be avoided as much as possible. The release of small bowel obstruction, the reduction of intussusception or the correction of retraction of the jejunum through the mesocolon can be accomplished readily. Double or single jejunostomy for feeding and decompression are all that is necessary in cases in which no cause can be found for obstruction at or below the stoma. In a patient with peptic ulcer, the use of enteroenterostomy below the stoma is unphysiological and will predispose to gastrojejunal ulcer at a later date.     

CT仿真结肠镜与腹部增强CT 在炎症性肠病诊断中的对比分析

目的:对比CT仿真结肠镜(CTC)与腹部增强CT在炎症性肠病诊断中的价值,为临床诊疗提供依据。方法:选取2015年1月到2016年1月我院收治的炎症性肠病患者60例为研究组,另选取非炎症性肠病患者60例为对照组,两组均30例患者接受CTC检查,30例患者接受腹部增强CT检查,对影像图片进行盲法阅读,将炎症性肠病的可信度分为5个等级进行评价,对6项影像学特征进行Logistic回归分析。结果:腹部增强CT对炎症性肠病诊断的准确率、敏感性、特异性分别为68.33%,59.09%,71.39%显著低于CTC的93.33%,95.01%、89.63%,比较差异具有统计学意义(P0.05);Logistic回归分析显示:结肠粘膜呈颗粒状、不光滑;肠壁强化并增厚;结肠袋消失对炎症性肠病具有预测作用;肠壁强化及增厚对炎症性肠病诊断敏感性较高,结肠粘膜呈颗粒状、不光滑联合结肠袋消失诊断炎症性肠病的特异性较高。结论:CTC对炎症性肠病具有较高的检出率,肠壁强化及增厚对炎症性肠病诊断的敏感性较高,结肠粘膜呈颗粒状、不光滑联合结肠袋消失诊断炎症性肠病特异性较高。     

电视胸腔镜术在老年小结节非小细胞肺癌患者治疗中的应用研究

目的:研究电视胸腔镜术在老年小结节非小细胞肺癌(Small nodules in non small cell lung cancer,sn NSCLC)患者治疗中的应用。方法:回顾2009年1月-2011年6月在我院接受电视胸腔镜术治疗的老年sn NSCLC88例患者的临床资料,按照手术方式将所有患者分为电视胸腔镜组与常规开胸组两个小组。电视胸腔镜组行电视胸腔镜术,常规开胸组行常规开胸术。观察两组患者手术指标、疼痛程度评分、手术前后1 d CRP、TNF-α、IL-6等炎性因子水平、术后并发症、1-3年生存率以及复发率等指标。结果:两组患者一般资料比较无统计学上的差异(P0.05)。电视胸腔镜组术中出血量、术后引流时间、下床活动时间以及疼痛程度评分及术后1 d CRP、TNF-α、IL-6等炎性因子水平及术后并发症发病率均显著低于常规开胸组(P0.05)。电视胸腔镜组术后1、2、3年生存率显著高于常规开胸组(P0.05),且术后复发率显著低于常规开胸组(P0.05)。结论:电视胸腔镜术治疗老年sn NSCLC创口小、恢复快,且有效避免过度激活炎性细胞,降低术后并发症发病率,值得应用于临床。