经肛型肠梗阻减压导管在急性低位结直肠梗阻中的应用

Clinlcal use of endoscopic ileus tube drainage in preoperative therapy for acute low malignant colorectal obstruction

目的初步评价经肛型肠梗阻减压导管在急性低位结直肠梗阻中的应用。方法2004年11月至2005年12月,对15例急性完全性机械性低位结直肠梗阻患者行肠梗阻导管置入术,冲洗引流7 d后手术。结果13例成功,患者术前腹围(91±4)cm,7 d后缩小到(82±2)cm；导管内每天引流量减冲洗量为-600～3200 ml；术后7 d腹部平片显示肠管扩张较术前明显好转,气液平面减少。手术中发现肠壁水肿不明显,增加了局部切除的可能。有2例治疗失败,其中1例系导丝无法通过狭窄部,另1例是肿块位于横结肠中部。结论肠梗阻减压导管治疗急性低位结直肠梗阻初步显示有效而安全。

Objective To evaluate the clinical use of endoscopic ileus tube drainage in preoperative therapy for acute low malignant colorectal obstruction. Methods From Nov. 2004 to Dec. 2005, 15 cases with acute low malignant colorectal obstruction received emergency colonoscopy and endoscopic ileas tube drainage was performed. Radical resection was then performed after seven days of drainage. Results Endoscopic ileas tube drainage was successful in 13 cases, and failed in 2 cases because the guide wire cannot be inserted through the tumor in one case, and in the other case the tumor was located in the middle of the transverse colon so that the ileus drainage tube was not long enough. Abdominal girth decreased from （91±4） cm to （82±2） cm after tube drainage. The everyday drainage volume minus riming volume ranged from -600 ml to 3200 ml. Abdominal X ray showed that obstruction was relieved. Intra-operative exploration revealed that colon edema was not evident, which increased resection rate. Conclusion Endoscopic ileus tube drainage is effective, safe and maybe the first choice of acute low malignant colorectal obstruction.