傣药"肠梗方"治疗肠梗阻临床体会

目的:观察"肠梗方",治疗肠梗阻的疗效.方法:使用傣、中药结合自拟"肠梗方"煎汤内服,连服5次.结果:痊愈27例,占93.10%,好转2例,占6.90%,总有效率为100%,无1例手术.结论:傣、中药"肠梗方"治疗肠梗阻具有显效快,疗程短、预后好、不留后遗症,免以手术痛苦的优点.提示:该方药不但可以治疗肠梗阻还可治疗多种原因引起的便秘症.

肠梗通内服方、灌肠方治疗术后粘连性肠梗阻52例临床观察

目的:观察自拟肠梗通内服方、灌肠方治疗术后粘连性肠梗阻的临床疗效。方法:将104例术后粘连性肠梗阻患者随机分为2组各52例,对照组采用禁食、奥曲肽皮下注射,持续胃肠减压、补水,维持酸碱平衡及水、电解质平衡,注射用头孢噻肟钠静脉滴注等治疗;观察组在对照组基础上加用肠梗通内服方、灌肠方治疗。2组治疗均为10天,观察比较2组临床疗效,患者治疗后排气、排便、胃管留置及住院时间,并对患者治疗前后的主要症状、体征进行评分比较。结果:临床愈显率观察组为88.46%,对照组为69.23%,2组比较,差异有统计学意义(P<0.05)。观察组治疗后的排气时间、排便时间、胃管留置时间及住院时间均短于对照组(P<0.01);治疗后,观察组腹胀腹痛、恶心呕吐、发热及肠鸣音评分均低于对照组(P<0.05)。结论:在西医常规治疗基础上,采用中药内服、灌肠治疗术后粘连性肠梗阻临床疗效明显,值得推广应用。

Endoscopic stenting-Where are we now and where can we go?

Self expanding metal stents (SEMS) play an important role in the management of malignant obstructing lesions in the gastrointestinal tract. Traditionally,they have been used for palliation in malignant gastric outlet and colonic obstruction and esophageal malignancy. The development of the polyflex stent,which is a removable self expanding plastic stent,allows temporary stent insertion for benign esophageal disease and possibly for patients undergoing neoadjuvant chemotherapy prior to esophagectomy. Potential complications of SEMS insertion include perforation,tumour overgrowth or ingrowth,and stent migration. Newer stents are being developed with the aim of increasing technical and clinical success rates,while reducing complication rates. Other areas of development include biodegradable stents for benign disease and radioactive or drug-eluting stents for malignant disease. It is hoped that,in the future,newer stents will improve our management of these diffi cult conditions and,possibly,provide prognostic as well as symptomatic benefi t in the setting of malignant obstruction.

Value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: A prospective evaluation

AIM: Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need for operative treatment, a potential therapeutic role of this agent in adhesive small bowel obstruction has been suggested. This study aimed at evaluating the effectiveness of gastrografin in adhesive small bowel obstruction when conservative treatment failed. METHODS: Patients with adhesive small bowel obstruction were given trial conservative treatment unless there was fear of bowel strangulation. Those responded in the initial 48 h had conservative treatment continued. Patients who showed no improvement in the initial 48 h were given 100 mL of gastrografin through nasogastric tube followed by serial abdominal radiographs. Patients with the contrast appeared in large bowel within 24 h were regarded as having partial obstruction and conservative treatment was continued. Patients in which the contrast failed to reach large bowel within 24 h were considered to have complete obstruction and laparotomy was performed. RESULTS: Two hundred and twelve patients with 245 episodes of adhesive obstruction were included. Fifteen patients were operated on soon after admission due to fear of strangulation. One hundred and eighty-six episodes of obstruction showed improvement in the initial 48 h and conservative treatment was continued. Two patients had subsequent operations because of persistent obstruction. Forty-four episodes of obstruction showed no improvement within 48 h and gastrografin was administered. Seven patients underwent complete obstruction surgery. Partial obstruction was demonstrated in 37 other cases, obstruction resolved subsequently in all of them except one patient who required laparotomy because of persistent obstruction. The overall operative rate in this study was 10%. There was no complication that could be attributed to the use of gastrografin. CONCLUSION: The use of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment is safe and reduces the need for suraical intervention

Colonic stenting vs emergent surgery for acute left-sided malignant colonic obstruction:A systematic review and meta-analysis

AIM:To investigate the effects of emergent preopera-tive self-expandable metallic stent (SEMS) vs emer-gent surgery for acute left-sided malignant colonic obstruction. METHODS:Two investigators independently searched the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, as well as references of included studies to identify randomized controlled trials (RCTs) that compared two or more surgical approaches for acute colonic obstruction. Summary risk ratios (RR) and 95% CI for colonic stenting and emergent surgery were calculated. RESULTS:Eight studies met the selection criteria, involving 444 patients, of whom 219 underwent SEMS and 225 underwent emergent surgery. Seven studies reported difference of the one-stage stoma rates between the two groups (RR, 0.60; 95% CI:0.48-0.76; P < 0.0001). Only three RCTs described the follow-up stoma rates, which showed no significant difference between the two groups (RR, 0.80; 95% CI:0.59-1.08; P = 0.14). Difference was not significant in the mortality between the two groups (RR, 0.91; 95% CI:0.50-1.66; P = 0.77), but there was significant difference (RR, 0.57; 95% CI:0.44-0.74; P < 0.0001) in the overall morbidity. There were no significant differences between the two groups in the anastomotic leak rate (RR, 0.60; 95% CI: 0.28-1.28; P = 0.19), occurrence of abscesses, including peristomal abscess, intraperitoneal abscess and parietal abscess (RR, 0.83; 95% CI:0.36-1.95; P = 0.68), and other abdominal complications (RR: 0.67; 95% CI: 0.40-1.12; P = 0.13). CONCLUSION:SEMS is not obviously more advantageous than emergent surgery for patients with acute left-sided malignant colonic obstruction.

Application of stilamin on advanced gastrointestinal carcinoma patients complicated with malignant bowel obstruction

Objective： To investigate the effectiveness of stilamin in malignant bowel obstruction （MBO） due to advanced gastrointestinal carcinoma patients. Methods： 62 patients with MBO due to gastrointestinal carcinoma were randomly divided into two groups： routine therapy group （control group 30 patients） and stilamin group （32 patients）. Stilamin group received routine therapy combined with stilamin （6 rag/d） by 24 hours continuous infusion for three to twelve days. The curative effectiveness was observed and compared between the two groups. Results： After treatment, the clinical symptoms of abdominal distention and abdominal pain were relieved significantly in stilamin group compared with the control group （84.4% vs 57.6%; P 〈 0.05）. The exhaust of anus was more earlier （62.1% vs 25.6%; P 〈 0.05）, and the average volume of gastrointestinal decompression reduced more rapidly in stilamin group compared with the control group [（216 ± 158） mL/d vs （522 ± 184） mL/d; P 〈 0.001）, smaller and less fluid-air in the intestinal and in the colon at the 81.3% of patients plain abdominal radiography were observed in stilamin group. Quality of life, evaluated with Karnofsky score （57 ±7 vs 45 ±9; P 〈 0.01）, was improved significantly. Conclusion： The administration of stilamin, in combination with routine treatment can be very effective in the management of MBO. It can effectively relieve the symptoms of MBO and improve the quality of life in patients.