巨大胆结石性肠梗阻的诊疗17例体会

Diagnosis and treatment of calculous ileus: report of 17 cases

目的探讨胆结石性肠梗阻的诊断和治疗方法。方法 2000年5月至2013年12月共收治结石性肠梗阻患者17例,回顾性资料显示该病术前诊断困难,围手术期治疗棘手,17例患者均系较大胆结石造成小肠梗阻,空肠梗阻5例,回肠梗阻12例。结果所有患者均治愈出院,平均住院日18.3 d。术后13例(76.5%)患者出现生命征(血压、血氧饱和度、心率等)不稳定;14例患者(82.4%)血电解质平衡紊乱,17例(100%)患者术后1周内白细胞、C反应蛋白升高;术后住院期间有3例(17.6%)患者腹腔内感染,加强抗感染治疗后治愈;出院后随访期内3例(17.6%)患者出现粘连性不全肠梗阻,对症处理后好转;未出现吻合口漏及远期营养不良等严重并发症;3年随访期内未出现因手术造成的死亡病例。结论胆结石性肠梗阻的诊断困难,手术是确诊的方法,也是治疗的主要手段。

Objective To investigate the diagnosis and treatment of calculous ileus. Methods The clinical data of 17 patients with calculous ileus treated from 2000 May to 2013 December were retrospectively analyzed, showing the difficulty of preoperative diagnosis and perioperative management of such disease .Of the 17 patients with intestinal obstruction casused by huge calculous ileus, 5 had jejunal obstruction and 12 had intestinal obstruction. Results All the patients were cured, and the average hospitalization was 18.3 days.After operation 13 patients （76.5%） had unstable vital signs, including blood pressure, oxygen saturation, and heart rate, whereas 14 patients （82.4%） had blood electrolyte balance disorder.All of the 17 patients （100%） had increased white blood cells and C reactive protein within 1 week after operation.In this series, 3 patients had abdominal infection （17.6%） cured by anti-infection treatment, 3 patients （17.6%） had incomplete adhesive intestinal obstruction, but no leakage and long-term malnutrition.No death occurred during a 3-year follow-up. Conclusion It is difficult to diagnose calculous ileus before operation, and surgical treatment is effective.