ABSTRACT
Intestinal obstruction is one of the most common diseases in abdominal surgery, and its prevention and treatment is a clinical difficulty. Although surgical operation can solve the symptoms of obstruction, there are many postoperative complications, and it is easy to develop re-obstruction due to postoperative abdominal adhesion. The internal fixation of small intestine with obstruction catheter provides a new idea for the prevention of postoperative adhesive bowel obstruction. The use of transanal ileus catheter provides the possibility of direct intestinal anastomosis after resection of malignant obstruction in the left hemicolon and can reduce the incidence of postoperative complications. However, sufficient attention should be paid to the related complications, and prevention and treatment should be planned. It is important to note that the use of obstruction catheter is only one of the conservative treatments for bowel obstruction, and it is not a complete replacement of surgery. Surgical treatment should still be considered, if the catheter fails to significantly move, if the obstructive symptoms do not significantly improve 5 days after catheterization.
Subject(s)
Humans , Catheters , Digestive System Surgical Procedures , Intestinal Obstruction/surgery , Intestine, Small , Tissue AdhesionsABSTRACT
Objective To investigate the feasibility and efficacy of endoscopic catheterization of ileus tube combined enterectomy for the treatment of elderly patients with acute sigmoid volvulus. Methods From August 2015 to August 2017,27 cases of elderly patients with acute sigmoid volvulus received treatment of endoscopic placement of ileus tube combined enterectomy in Pudong New Area Gongli Hospital.Retrospectively collected clin-ic parameters of pre-catheterization,post-catheterization,enterectomy and postoperative follow-up;the success rate of catheterization and enterectomy,compression efficiency,post-operative complications,and efficacy of the com-bined therapy were analyzed. Results Emergency catheterizations of anorectal ileus tube were succeeded in 27 (100%)patients;one patient who developed intestinal gangrene received emergency enterectomy,the hemogram and internal environmental disturbance of the 26 cases were significantly relieved,and the efficacy rate of decom-pression was 96.3%. The success rate of was enterectomy was 100%;the incidence of severe complications and mortality were 22.2% and 3.7%,respectively. During the follow-up,2(7.4%)patients developed ileus,and the efficacy rate of the combined therapy was 85.2%. Conclusions The catheterization of ileus tube could effectively depress intestinal pressure. The success rate of enterectomy was significantly improved and postoperative mortality was reduced. The therapy of endoscopic ileus tube catheterization combined enterectomy is a safe and effective method for the treatment of acute sigmoid volvulus in the elderly.
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Objective To explore the feasibility and the clinical effect of laparoscopic treatment of incomplete small intestinal obstruction.Methods Eighty-five patients with intestinal obstruction from January 2011 to January 2016 were analyzed retrospectively.Five cases caused by adhesion band were released by laparoscopic cut of the adhesion band.Seventy-five cases were caused by adhesion between intestine, abdominal wall, and pelvic cavity were given laparoscopic adhesion and angle separation.Laparoscopic exploration found appendicitis in 3 cases and a laparoscopic appendectomy was carried out.Two cases were given laparoscopic removal of foreign body inside the intestine.For patients with obvious abdominal distention, an indwelling ileus tube was placed in the intestine before the operation.Results All the laparoscopic surgeries were successfully performed except 2 patients required an additional small incision to perform partial enterectomy and intestinal anastomosis due to intensive local adhesion.No complications happened.Postoperative follow-ups for 3-60 months (mean, 35 months) found no recurrence.ConclusionsLaparoscopic treatment of small intestinal obstruction is feasible and minimally invasive, having advantages of small incision, rapid recovery and short hospitalization.It avoids the trauma caused by open operation.
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Objective To explore the method and clinical effect of via -nasal ileus tube combined urografin to treat early postoperative inflammatory intestinal obstruction.Methods Retrospective analyzed the data of 27 patients with early postoperative inflammatory intestinal obstruction who treated through via -nasal ileus tube intervention. Results The 27 patients were cured through conservative treatment and the cure rate was 100%.The symptom of 10 cases got complete remission 4 to 7 days after put the ileus tube,17 cases got complete remission 8 to 13 days. The passage of gas by anus recovery time was average (12.3 ±2.6)days,time of therapy was average (16.1 ± 3.7)days.The patients were followed up for 6 months to 1 year,none of the patients relapsed.Conclusion The early postoperative inflammatory intestinal obstruction should be treated through conservative treatment positively,decom-pression by via -nasal ileus tube combined urografin has important role to diagnose and treat the disease,the therapy can enhance the therapeutic effect validly and shorten the treatment cycle,it is safe to use in clinic and the effect is satisfactory.
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Objective To investigate the clinical application of nasal-insertion type ileus-tube in the treatment of adhesive small intestinal obstruction. Methods A total of 221 patients with simple adhesive small intestinal obstruction, who were admitted to authors’ hospital during the period from January 2010 to Aug. 2014, were enrolled in this study. The patients were randomly divided into nasal-insertion type ileus-tube group (n=111) and nasogastric tube group (n=110). After the procedure, the patients were kept under close observation, focusing on the abdominal distention, gastrointestinal decompression amount, the recovery time of anal exhaustion and defecation, the vanishing time of intestinal air-liquid plane on erect abdominal X-ray film, etc. The cure rate, effective rate and transit-operation rate were calculated. The results were compared between the two groups. Results The tube placement operation was successfully performed in all patients. Compared with the nasogastric tube group, in the nasal-insertion type ileus-tube group the recovery time of abdominal distention, anal exhaustion and defecation and the vanishing time of intestinal air-liquid plane on erect abdominal X-ray film were obviously shorter, and the gastrointestinal decompression amount was larger. In the nasal-insertion type ileus-tube group the cure rate and effective rate were significantly increased, while the transit-operation rate was decreased; the differences between the two groups were statistically significant (P<0.05). Conclusion For the treatment of adhesive small intestinal obstruction, the placement of nasal-insertion type ileus-tube is effective and reliable. This technique can strikingly improve the clinical symptoms, therefore, it is worthy of promotion and application in clinical practice.
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Objective To investigate the effect of via-anal ileus tube used as a drainage in left-sided acute malignant colonic obstruction.Methods Forty-seven cases of left-sided acute malignant colonic obstruction were divided into control group (25 cases) and tube group (22 cases).The patients in control group received intraoperative colonic lavage for one-stage surgery.The patients in tube group received via-anal ileus tube for decompression before the surgery.Compared the difference of bowel movement recovery time,exhaust time,fasting time,postoperative hospitalization time,hospitalization costs and complication rate between two groups.Results The technically successful rate in tube group was 90.9％ (20/22),and one-stage surgery were performed.No anastomotic leakage or postoperative stenosis occunred after operation.There were 23 cases in control group who performed coloclysis in operation and one-stage surgery.The bowel movement recovery time,exhaust time,fasting time,postoperative hospitalization time and hospitalization costs in tube group were significantly lower than those in control group [(12.78 ± 2.07) h vs.(18.01 ±3.42) h,(78.76 ± 11.43) h vs.(96.38 ±13.09) h,(3.18 ±1.76) d vs.(5.51 ±2.95) d,(10.23 ± 2.33) d vs.(15.86 ± 6.74) d,(25 437.43 ± 2 343.67) Yuan vs.(31 051.32 ± 2 542.73) Yuan](P ＜ 0.01 or ＜ 0.05).After operation,there were 2 cases of stomas fistula and 2 cases of peritoneal cavity infection in control group,and none of them in tube group,the complication rate in control group was significantly higher than that in tube group [17.4％ (4/23) vs.0,P ＜ 0.05].Conclusions The via-anal ileus tube used as a drainage in left-sided acute malignant colonic obstruction is effective and safe,and can improve the rate of one-stage anastomoses,decrease the complication rate,promote the promote.It has important clinical value.
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Objective To investigate the clinical efficacy of colonoscopic metal stenting and ileus tube catheteriza-tion on left colorectal cancer with acute obstruction. Methods Clinical data of 80 patients meeting the diagnostic criteria for acute obstruction of the left half of colorectal cancer were included in this study. Patients were randomly divided into met-al stent group (n=40) and ileus tube group (n=40). The metal stent group was treated by metal stent and the ileus tube group was treated by ileus tube. Both were carried on by colonoscopy and X-line. After the relief of obstruction ( 7-10 d), patients were underwent colorectal cancer radical resection and anastomosis. The technical operations, improvement of obstruction and the efficacy of surgical treatment were compared between two groups. Results The success rate was 87.5%in metal stent group and the 97.5%in ileus tube group. There was no significant difference in the success rate between two groups (P>0.05). No complications were found in two groups. The operation time and the treatment cost were higher in metal stent group than those in ileus tube group. The relief rates of obstruction were 100%and 95%for metal stent group and ileus tube group, and there was no difference between them. Two cases were operated for emergency because of the failure of obstruc-tion relief. The relief time of obstruction and the difference between C-reactive protein values were much better in metal stent group than those of ileus tube group. After the obstruction relief, patients underwent a radical resection of the tumor and anastomosis, no anastomotic leakage was found in two groups. There were no significant differences in the operation time, in-cision infection and hospitalization time between two groups. Conclusion Anal ileus tube catheterization has a better eco-nomic value in the treatment of acute obstruction, but the efficacy of metal stent is better.