急性结肠假性梗阻的诊治进展

The progress of diagnosis and treatment of acute colonic pseudo obstruction

急性结肠假性梗阻(acute colonic pseudo-obstruction,ACPO)逐步为临床所认知,但很多方面还有待深入研究,其诊治依然是临床医生需要面临的挑战。随着对ACPO病因病理的深入了解,其流行病学也在发生着改变。结肠梗阻患者应警惕ACPO,一般情况下,多可通过影像学检查排除机械性梗阻。早期诊断是关键,保守治疗多可治愈。保守治疗无效者可尝试新斯的明药物治疗,但目前用药浓度、给药方式尚存争议。对于新斯的明治疗无效及复发的问题亟需研发新的药物。药物治疗禁忌或疗效欠佳者可行内镜治疗,放置减压管或经皮内镜下盲肠造瘘术等新技术有着良好的临床疗效。手术干预作为治疗最终手段,往往伴随着较高的死亡率和并发症。因此,临床医师应全面了解所有治疗手段,综合使用保守、药物和内镜治疗,造福患者。

The clinical knowledge of ACPO (acute colorectal pseudo-obstruction) is progressively improving but there is a lot of further studies to be done; the diagnosis and treatment are still a challenge for clinical practitioners. With respect to the deep understanding of ACPO, etiology and epidemiology are also undergoing changes. ACPO should be alerted in patients with intestinal obstruction and mechanical obstruction should be ruled out through imaging studies. Early diagnosis is the key, conservative treatment can be tried as the next step in management but the concentration of drug needs to be ensured. There is need for research to be done about new drugs for ACPO and prevent its? relapse. Endoscopic treatment is feasible when met with contraindications for drug treatment or poor efficacy of drugs; new technologies of endoscopy such as vacuum tube or endoscopic cecal gastrostomy have provided effective clinical effect. The last resort of treatment is surgical intervention but it is accompanied with high mortality and complications. Therefore,clinicians should be fully aware of all treatment methods; comprehensive use of conservative treatment and endoscopy for the welfare of the patients.