如何控制术后炎性肠梗阻的“蝴蝶效应”--以肠瘘术后为例探讨

How to control the"butterfly effect"of postoperative inflammatory ileus--A case study of postoperative intestinal fistula

目的通过分析呈现个体化方案成功治疗1例肠瘘术后进行性加重炎性肠梗阻的案例,为难治性、复杂性术后炎性肠梗阻提供规范的观察治疗思路。方法对2020年11月3日南京中医药大学附属医院普外科收治的1例外院常规保守治疗效果不佳术后炎性肠梗阻病人的病例特点、治疗方式和治疗效果进行研究分析。结果1例因常规保守治疗43 d失败的术后炎性肠梗阻病人,通过抗炎、小肠梗阻导管肠道减压、肠外营养联合肠内营养治疗等其他对症治疗25 d后,临床相关指标较治疗前改善显著,肠梗阻导管引流量显著减少、前白蛋白、CD3+和CD4+T淋巴细胞指标明显升高、超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)明显降低、腹部CT检查结果明显改善,最终痊愈出院。结论降低炎症反应、改善营养功能、及时针对性肠道减压是治疗术后炎性肠梗阻关键措施。

Objective To provide a standard observation and treatment for refractory and complicated postoperative inflammatory il⁃eus by presenting and analyzing a case of successful individualized treatment for progressive exacerbation of postoperative inflammato⁃ry ileus.Methods A patient with postoperative inflammatory ileus,who had poor efficacy of conventional conservative treatment and then was admitted to Department of General Surgery of The Affiliated Hospital of Nanjing University of Chinese Medicine on November 3,2020,was investigated and analyzed in terms of case characteristics,treatment and efficacy.Results The postoperative inflammato⁃ry ileus patient,who experienced failure in 43 d conventional conservative treatment,achieved significantly better results of clinical in⁃dexes through anti-inflammatory treatment,catheter intestinal decompression for small intestinal obstruction,and parenteral nutrition in combination with enteral nutrition therapy for 25 d.The volume of drainage was significantly reduced,the level of prealbumin,CD3+and CD4+T lymphocyte counts increased significantly,and the levels of hypersensitive C-reactive protein(hs-CRP)and interleukin 6(IL-6)decreased obviously.The results of abdominal CT examination significantly improved,and the patient eventually recovered and was discharged from hospital.Conclusion Reduction in inflammatory response,improvement in nutritional function and timely target⁃ed intestinal decompression are the key measures for the treatment of postoperative inflammatory ileus.