DSA引导下经鼻肠梗阻减压导管置入术治疗粘连性小肠梗阻

Application of DSA guided transnasal ileus tube placement in the treatment of adhesive small intestinal obstruction

目的探讨DSA引导下经鼻肠梗阻减压导管置入术在粘连性小肠梗阻中的应用价值。方法应用DSA引导下经鼻置入肠梗阻减压导管对20例单纯性粘连性小肠梗阻患者进行治疗,观察临床疗效、经导管选择性造影情况及随访情况。选择同期进行传统保守治疗的粘连性小肠梗阻患者20例作对照,比较治愈率、有效率、中转手术率、24h引流量、症状改善时间、住院时间。结果全部病例均一次性插管成功,技术成功率100%,无术中并发症发生。前气囊充盈后,18例导管前进良好,2例无明显前进。经导管造影显示16例肠管通畅,2例见肠管狭窄,1例肠管增粗,1例肠管扭曲。导管组治愈16例,好转2例,未愈2例;保守组治愈9例,好转5例,未愈6例。导管组与保守组治愈率、中转手术率、24小时引流量分别为80.00%与45.00%、10.00%与40.00%、(960±247)ml与(410±210)ml(P均<0.05),有效率分别为90%与70%(P>0.05)。治愈与好转的病例中,导管组与保守组症状缓解和住院时间分别为3.8天与10.3天(P<0.01)、10.5天与19.2天(P<0.05)。结论经鼻肠梗阻减压导管置入术治疗单纯性粘连性小肠梗阻疗效确切,可明显提高治愈率,降低中转手术率,快速改善临床症状,缩短住院时间。

Objective To evaluate the clinical application value of DSA guided transnasal endoscopic ileus tube placement in the treatment of adhesive small intestinal obstruction.Methods Twenty patients with simple adhesive small intestinal obstruction were treated with DSA guided transnasal endoscopic ileus tube placement in the treatment,while other 20 patients of adhesive small intestinal obstruction received conservative treatment.The cure rate,effective rate,operability,drainage flow within 24 h,symptoms relieving time and hospital stay were compared between groups.Results Technical success was conducted in all patients in tube group,and no complication occurred.Tube going smoothly was observed in 18 patients after front balloon was filled,whereas tubes did not go ahead in 2 patients.Selective enteroclysis showed intestinal smooth in 16 patients,stenosis in 2,enlargement in 1 and distortion in 1 patient.The patients of cure,improvement and invalidation were 16,2,2 in tube group and 9,5,6 in conservative group.Cure rate,effective rate,operability,drainage flow within 24 h,symptoms relieving time and hospital stay was 80.00% and 45.00%（P〈0.05）,90.00% and 70.00%（P〉0.05）,10.00% and 40.00%（P〈0.05）,（960±247）ml and（410±210）ml（P〈0.05）,3.8 d and 10.3 d（P〈0.01）,10.5 d and 19.2 d（P〈0.05）in tube group and conservative group,respectively.Conclusion Transnasal ilues tube placement can improve cure rate,decrease operability,improve clinical symptoms quickly and shorten hospital stay in the treatment of adhesive small intestinal.