结肠镜检查前服甘露醇致急性肠梗阻原因分析

Analysis of reason for mannite causing acute intestinal obstruction before colonoscopy

目的：探讨分析结肠镜检查前服甘露醇致急性肠梗阻的原因。方法选取2005年7月~2013年12月本院288例考虑肠道占位性病变患者,结肠镜检查术前4 h口服甘露醇注射液,对发生急性肠梗阻患者的临床资料进行对比分析,探讨甘露醇致急性肠梗阻的原因。结果患者在服甘露醇后,当天有37例（12.85%）患者出现急性肠梗阻症状,使用胃肠减压、抗炎等治疗措施后,31例好转,6例症状无缓解行急诊手术治疗,切除病变组织同时进行一期消化道重建吻合3例,切除病变组织后,进行结肠造瘘3例。后经确诊35例为肠道占位性病变患者（乙状结肠癌、降结肠癌、直肠癌以及横结肠癌）,1例回盲部结核,1例未发现明确病因。结论由于甘露醇的高渗透压作用以及分解代谢产生大量气体,所以对高度怀疑有肠道占位性病变的患者,进行结肠镜检查前,不宜选用甘露醇行肠道准备,应以灌肠方法或选用其他泻药作为肠道准备的主要措施。

Objective To analyze the cause of acute intestinal obstruction for intestinal lesions （undiagnosed） patients, in the colonoscopy before taking mannitol for bowel preparation, were analyzed. Methods There were 288 cases patients with suspected intestinal lesions in our hospital from July 2005 to December 2013, 4 h before colonoscopy oral l injecting mannito for 250ml, and half an hour fast drinking 1500 ml, to investigate the causes of acute intestinal obstruction caused by mannitol. Results Patients in the service of mannitol, the acute intestinal obstruction symptoms accounted for 37 cases（12.85%）, and were diagnosed as carcinoma of sigmoid colon, after 35 cases were diagnosed as intestinal lesions （sigmoid colon, descending colon cancer, rectal cancer and transverse colon cancer）, 2 cases of non intestinal lesions. Conclusion Due to the high osmotic pressure and large amounts of gas metabolism produced of mannitol, so patients who were highly suspected for intestinal lesions of colonoscopy, should use enema or other laxatives instead of mannitol as bowel preparation.