X线下经鼻肠导管小肠排列治疗黏连性肠梗阻的临床研究

Clinical application of nasal-intestinal intubation small intestinal arrangement under radiophotography in adhesive ileus

目的探讨在X线监视下经鼻置入肠梗阻导管进行非手术小肠支撑排列,治疗黏连性肠梗阻的临床经验与疗效。方法25例术后反复黏连性小肠梗阻患者,X线监视下经内置金属导丝的引导作用将300cm长的肠梗阻导管经鼻置入空肠屈氏韧带20cm以远,即刻小肠内抽吸减压,导管前气囊充水形成水囊,模拟食团在肠蠕动的推动下在小肠内移行,带动导管边吸引减压边向小肠远端前行,到达梗阻的直接上部抽吸减压或通过黏连部至回肠末端全小肠减压,解除肠梗阻。保留横贯全小肠的导管作为肠内支架进行小肠内支撑,预防黏连复发。结果X线下导管置入空肠时间(13±11)min(9～36min),成功率为88%,另外3例借助胃镜辅助置入。25例肠梗阻解除21例,解除率为84%,3例转手术,1例因肺部感染、呼吸衰竭带管死亡。21例梗阻解除后进行小肠排列,排列时间(18.5±3.0)d。随访6个月～2年,1例7个月后再发黏连予以重复治疗,其余20例随访期内均未复发。结论X线下置入鼻肠导管小肠排列治疗术后反复黏连性肠梗阻简便安全,解除黏连性肠梗阻的同时可以有效预防黏连复发,必要时可以重复治疗。

Objective To discuss the clinical experience and curative effect of pernasal intestinal intubation non-operative internal intestinal arrangement under radiophotography in treatment of adhesive ileus. Methods Three hundred cm-long ileus tube was installed into jejunum by nasal cavity under radiophotography observation in 25 cases with recurrent postoperative adhesive ileus, ileus tube was impulsed by enterokinesia to ileum end to relieve adhesive ileus and conduct internal intestinal arrangement. Results The duration for installation of tube under radiophotography is（ 13 ±11 ） minutes（9 - 36 minutes）, and achievement ratio is 88% ,with 3 exceptional cases conducted with the help of gastroscope,21 out of 25 are successfully relieved and the relief rate is 84% , time for intestinal arrangement after relief is （ 18.5 ±3 ） d. During the flup of 6 mouths to 2 years, one was recurred because of recurrence, while other 20 were recovered smoothly with no recurrence. Conclusions Non-operation intestinal intubation internal intestinal splinting under radiophotography is a simple, safe and effective management with less complications and reliable outcome in treating recurrent postoperative adhesive ileus.