ObjectiveTo explore the feasibility and safety of the artificial pneumoperitoneum and gastrointestinal contrast CT imaging, and imaging diagnostic value on abdominal wall adhesion to intestine after operation. MethodsThirtynine patients with adhesive intestinal obstruction after operation relieved by conservative therapy were included from January 2008 to November 2009. After the artificial pneumoperitoneum established by injection of gas into abdominal cavity and gastrointestinal comparison by oral administration low concentration of meglucamine diatrizoate, CT scan imaging was performed and the radiographic results were compared with surgical findings. ResultsFour patients refused surgery and discharged, so enterolysis was performed in the remaining patients. The surgical findings were consistent with radiographic results. It was showed by laparoscopic operation that intestinal obstruction caused by the fibrous adhesions and the intestine did not adhere to the abdominal wall in eight patients with fibrous adhesion diagnosed by CT. Of eighteen patients with the abdominal wall septally adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed “M”type adhesions and omentum adhesions in sixteen patients underwent open operation, and clear fat space was showed in eight patients and close adhesion was found in another eight patients between the intestine and abdominal wall. Of thirteen patients with the abdominal wall tentiformly adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed continuous and tentiform adhesions and omentum adhesions to the intestine in eleven patients. After the followup of 6-18 months (mean 9 months), incomplete intestinal obstruction occurred in one patient and was relieved by conservative treatment. One patient with discontinuous discomfort in abdomen after operation did not receive any treatment. The other patients were cured. ConclusionThe artificial pneumoperitoneum and gastrointestinal contrast CT imaging can accurately show the location, area, and structure composition of the postoperative abdominal wall adhesion to intestine, which is safety, simple, and bly repeatable, and a better imaging method for the diagnosing of abdominal wall adhesion to intestine after operation.
目的提高广泛粘连性肠梗阻的治疗效果，预防粘连性肠梗阻复发。方法分析我院1994年1月至2000年5月6年间手术治疗28例广泛粘连性肠梗阻的临床资料。结果手术后无肠梗阻复发，术后8例发生切口感染，无手术死亡及肠瘘发生。结论把握好手术时机是提高粘连性肠梗阻治疗效果的关键，肠排列术是预防粘连性肠梗阻的一个有效方法。
目的探讨粘连性肠梗阻的病因、诊断及治疗。方法对1996～2001年我科收治的149例粘连性肠梗阻患者的临床资料进行回顾性总结、分析。结果本组149例均发生于腹腔手术后，主要症状是腹痛、腹胀、呕吐、肛门停止排气、排便，体征为腹胀、肠型、肠鸣亢进、腹部压痛。行腹部X线平片检查140例，泛影葡胺胃肠道造影18例,149例均确诊，其中不完全性肠梗阻112例，完全性肠梗阻37例。行非手术治疗123例,手术治疗26例，全组均治愈或好转。结论腹腔手术是形成粘连性肠梗阻的主要因素，诊断主要依靠病史、体征及腹部X线摄片检查，泛影葡胺胃肠道造影对明确梗阻部位有较大帮助，也有一定治疗作用。粘连性不全性肠梗阻非手术治疗成功率高，而完全性肠梗阻或出现肠绞窄时应积极手术，掌握手术时机十分重要。
Objective To array the small intestine so that the uncontrollable adhesions will turn to controllable abhesions in order to prevent the intestinal obstruction. Methods Literatures were reviewed. The advance of plication of small intestine has passed through three stages: 1st, sewing the intestine just like the array of harpsichord keys; then, using straight needle with coarse threads to make a ‘U’ suture for the mesentery of small intestine so the intestine was arrayed, and 3rd inserting a Millers-Abbott tube into the lumen of small intestine followed by manual arrangement of the intestine. Results Using the Millers-Abbott tube the intestine was fixed in a steady position and arrayed in a half moon circular shape to avoid sharp angle. As a result, the intra-luminal pressure of the intestinal was effectively decreased. Follow up 45 cases showed the cure rate of 91.9%. Conclusion This operation has widely been accepted by the surgeons for its simplicity, high efficacy and reliability. It reduces the recurrence rate of adhesive obstruction.
ObjectiveTo study the effect of octreotide on acute adhesive intestinal obstruction． MethodsFifty-two patients with adhesive intestinal obstruction from January 2009 to January 2011 in this hospital were divided into octreotide treatment group (n=28) and routine treatment group (n=24) according to the treatment methods. Apart from routine treatments, octreotide was administrated in the octreotide treatment group while traditional treatment in the routine treatment group．The effectiveness was observed and compared between two groups. ResultsThe cure rate of the octreotide treatment group was significantly higher than that of the routine treatment group (Plt;0.05). The anus exhausting and defecating time was earlier, hospitalization time was shorter, and gastrointestinal decompression of the treatment octreotide group as compared with the routine treatment group (Plt;0.05)． ConclusionConventional therapy combining with intravenous infusion of octreotide in patients with acute adhesive intestinal obstruction can improve the clinical symptoms and success rate of treatment．
Objective To approach the convenient prediction methods about surgical indications of adhesive ileus. Methods Two thousand and thirtyfour patients with adhesive ileus were analyzed retrospectively between January 1996 and January 2010 in the Department of General Surgery, The First Affiliated Hospital of Anhui Medical University， and 1 992 patients were included into this model. Seventeen factors which could influence the surgical decisions, including period of intestinal obstruction (X1), frequency of attack (X2), history of operation on abdominal region (X3), continuous and severe abdominal pain (X4), severe or frequent vomiting (X5), severe abdominal distention (X6), hemafecia (X7), fever (X8), heart rate (X9), shock or hypotension (X10), touching a swell ansa intestinalis (X11), hypoactive bowel sound (X12), peritonitis (X13), white blood cell (WBC) count of peripheral blood (X14), obstruction ansa interstinalis fixation and a severe expansion by abdominal erect position plain film (X15), peritoneal cavity free air (X16), and seroperitoneum whether or not by B ultrasonic examination (X17) were analyzed by binary logistic regression. Then prediction schedule whether patients with adhesive ileus needed emergency operation was gained by the theory of logistic regression analysis. Results Eight items were included in the prediction model by the method of forward stepwise which were X1, X2, X4, X9, X13, X14, X15, and X17, respectively. The probability of operation could be calculated by the following formula: logit(P)=expZ/（1+expZ）, where, Z={-7.813+〔-1.942×X1(1)/2.290×X1(2)/2.765×X1(3)〕+2.801×X2+2.692×X4+10.610×X9(1)/13.279×X9(2)+3.422×X13+〔-3.048×X14(1)/16.992×X14(2)〕+6.113×X15+2×X17}， which X1（1）, X1（2）, and X1（3） were periods of intestinal obstruction 3－5 d, 5－7 d, and ≥7 d, respectively. X9(1) and X9(2) were heart rates of 60－100/min and ≥100/min, respectively. X14(1) and X14(2) were WBC counts of peripheral blood of (10-20)×109/L and ≥20×109/L， respectively. The patient had to accept surgical procedure when the value of P was more than 0.5. The coincidence was 99.00%, sensitivity was 96.17%, specificity was 99.53% in 1 992 patients. The coincidence was 96.20%, sensitivity was 90.00%, specificity was 96.84% in 105 patients between January 2010 and April 2010 in this hospital. Conclusion The prediction schedule is a good useful value, but the coefficients is corrected following the cases increasing.
目的 探讨腹腔镜下治疗粘连性肠梗阻的可行性和效果。 方法 分析在腹腔镜下对粘连性肠梗阻行粘连松解术的33例病例。结果 33例均顺利完成腹腔镜下粘连松解术，术后恢复好，无手术并发症发生； 随防6～15个月，均无腹痛、腹胀等症状复发。结论 利用腹腔镜对粘连性肠梗阻有选择地进行粘连松解手术安全、可行，能提高粘连性肠梗阻的治疗效果。
目的 观察泛影葡胺在粘连性肠梗阻中的诊断及治疗效果和手术时机的选择。方法 对137例粘连性肠梗阻患者经胃管注入76%泛影葡胺60~100 ml行胃肠道造影，通过腹部X线摄片动态观察造影剂在胃肠道中的位置及通过情况，以确定梗阻部位以及梗阻是否完全，从而确定手术时机。结果 137例中103例造影剂在6~24 h后到达结肠而给予保守治疗，平均症状缓解时间为14.8 h，1~6 d (平均3.3 d)后症状消失。另34例见造影剂不能到达结肠且症状体征加重而行手术治疗,痊愈。结论 泛影葡胺胃肠道造影在对粘连性肠梗阻明确梗阻部位及手术时机的选择方面有很好的指导作用，可作为临床医师诊断与治疗粘连性肠梗阻的一种手段。