【摘要】：背景腸梗阻導管出現(xiàn)并用于治療急性腸梗阻已有近100年的時間,現(xiàn)已成為急性腸梗阻患者保守治療的重要方法,國內(nèi)外已經(jīng)有多項研究肯定了腸梗阻導管對于急性腸梗阻的療效。傳統(tǒng)的腸梗阻導管置入方法為在DSA透視機下,配合導絲引導,將導管置入小腸。在置管過程中,隨著深度的增加,導絲與管腔之間的摩擦力會明顯增大,而且插管過程中會遇到小腸粘膜皺襞阻擋,這些因素導致操作者往往僅將導管頭端置入十二指腸或通過十二指腸懸韌帶,置入空腸上段即停止操作,導管頭端并沒有充分接近梗阻部位。雖然導管可以隨腸蠕動下行,但因為腹膜炎、電解質(zhì)紊亂、應用止疼藥等原因,患者往往合并腸動力障礙,使導管下行受阻,減壓效果不理想。針對腸梗阻導管置管過程中遇到的困難,我們采用了斑馬導絲、數(shù)字平板機等設(shè)備,改進置管方法,置管深度大幅度提高,最深可達265cm,減壓效果也明顯提高。目的研究深度置管方法與傳統(tǒng)置管方法對于急性腸梗阻治療效果的差異。方法回顧分析了經(jīng)影像學檢查確診為急性腸梗阻并行經(jīng)鼻型腸梗阻減壓管治療的患者共183例。95例接受深度置管方法置入導管,88例接受傳統(tǒng)置管方法(對照組)。對照不同置管方法對急性腸梗阻治療的效果差異。結(jié)果1、深度置管組平均置管深度明顯大于傳統(tǒng)置管組,P0.01;2、置管完成后24小時,深度置管組引流量明顯多于傳統(tǒng)置管組,P0.01;術(shù)后24、48小時疼痛評分明顯低于傳統(tǒng)置管組,且48小時腹痛緩解率明顯增高,P0.01;置管后排氣排便恢復時間及腹部立位平片緩解時間也短于傳統(tǒng)置管組,P0.05;置管術(shù)后24、48小時,排氣排便率及腹部立位平片緩解率均高于傳統(tǒng)置管組,P0.05;兩組患者需手術(shù)解除梗阻率及總體有效率的差異無統(tǒng)計學意義,P0.05;但深度置管組急癥手術(shù)率降低,P0.05。3、對于黏連性腸梗阻,深度置管方法的治療效果優(yōu)于傳統(tǒng)置管方法,,P值均0.05;對于癌性及糞石性梗阻,兩種置管方法療效無統(tǒng)計學意義,p0.05。結(jié)論相對于傳統(tǒng)置管方法,采用深度置管方法可使導管更加接近梗阻部位,充分減壓梗阻近端腸管,更有效、更迅速得改善患者癥狀,降低急癥手術(shù)率,尤其對于黏連性腸梗阻效果顯著。對于癌性腸梗阻及糞石性腸梗阻,兩種置管方法的總體療效相當。
[Abstract]:Background: the catheter of intestinal obstruction has been used in the treatment of acute intestinal obstruction for nearly 100 years, and it has become an important method for conservative treatment of patients with acute intestinal obstruction. There have been a number of studies at home and abroad to confirm the efficacy of intestinal obstruction catheter for acute intestinal obstruction. The traditional method of catheterization for intestinal obstruction is to insert the catheter into the small intestine under the guidance of the guide wire under the DSA perspective machine. In the process of catheterization, the friction between the guide wire and the lumen will obviously increase with the increase of the depth, and the small intestinal mucosal fold obstruction will be encountered during the intubation process. These factors led the operator to place the catheter only at the end of the duodenum or through the duodenum suspension ligament, and to stop operation when placed in the upper segment of the jejunum. The end of the catheter was not sufficiently close to the site of the obstruction. Although the catheter can follow the intestinal peristalsis, but because of peritonitis, electrolyte disorder, the use of painkillers and other reasons, patients often complicated with intestinal motility disorders, so that the catheter down is blocked, the effect of decompression is not satisfactory. In view of the difficulties encountered in the catheterization of intestinal obstruction, we adopted zebra guide wire, digital plank machine and other equipment to improve the method of tube placement. The depth of tube placement is greatly increased, the deepest can reach 265 cm, and the effect of decompression is also improved obviously. Objective to study the difference between deep catheterization and traditional catheterization in the treatment of acute intestinal obstruction. Methods 183 cases of acute intestinal obstruction and nasal intestinal obstruction treated with decompression tube were retrospectively analyzed. 95 cases received deep catheterization and 88 cases received traditional catheterization (control group). The effect of different catheterization methods in the treatment of acute intestinal obstruction was compared. Results (1) the average depth of catheterization in the deep tube group was significantly greater than that in the traditional tube placement group (P 0.01). 24 hours after the placement, the drainage volume in the deep tube insertion group was significantly more than that in the traditional tube placement group (P 0.01). The pain score of 48 hours after operation was significantly lower than that of traditional tube placement group, and the relief rate of abdominal pain at 48 hours was significantly higher (P 0.01), and the recovery time of exhaust and defecation after intubation and the time of abdominal orthostatic flat film relief were shorter than those of traditional tube placement group (P 0.05). 24 and 48 hours after catheterization, the defecation rate and the remission rate of abdominal orthostatic flat film were higher than those of the traditional catheter placement group, P 0.05. There was no significant difference between the two groups in the rate of removing obstruction and the overall effective rate (P 0.05). However, the acute operation rate of the deep catheterization group was lower, P 0.05.3. For adhesive intestinal obstruction, the treatment effect of the deep catheterization method was better than that of the traditional catheterization method. The, P values of the deep catheterization group were 0. 05; For carcinomatous and fecal obstruction, there was no significant difference in the efficacy of the two catheterization methods, p 0.05. Conclusion compared with the traditional catheterization method, the method of deep catheterization can make the catheter closer to the site of obstruction, fully decompress the proximal intestinal tube, be more effective, improve the symptoms of patients more quickly, and reduce the rate of emergency operation. Especially for adhesive intestinal obstruction, the effect is remarkable. For carcinomatous intestinal obstruction and fecal ileus, the overall efficacy of the two catheterization methods is the same.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R656.7

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