肠梗阻导管深度置管法治疗急性肠梗阻的效果研究

发布时间：2019-03-26 21:17

【摘要】：背景肠梗阻导管出现并用于治疗急性肠梗阻已有近100年的时间,现已成为急性肠梗阻患者保守治疗的重要方法,国内外已经有多项研究肯定了肠梗阻导管对于急性肠梗阻的疗效。传统的肠梗阻导管置入方法为在DSA透视机下,配合导丝引导,将导管置入小肠。在置管过程中,随着深度的增加,导丝与管腔之间的摩擦力会明显增大,而且插管过程中会遇到小肠粘膜皱襞阻挡,这些因素导致操作者往往仅将导管头端置入十二指肠或通过十二指肠悬韧带,置入空肠上段即停止操作,导管头端并没有充分接近梗阻部位。虽然导管可以随肠蠕动下行,但因为腹膜炎、电解质紊乱、应用止疼药等原因,患者往往合并肠动力障碍,使导管下行受阻,减压效果不理想。针对肠梗阻导管置管过程中遇到的困难,我们采用了斑马导丝、数字平板机等设备,改进置管方法,置管深度大幅度提高,最深可达265cm,减压效果也明显提高。目的研究深度置管方法与传统置管方法对于急性肠梗阻治疗效果的差异。方法回顾分析了经影像学检查确诊为急性肠梗阻并行经鼻型肠梗阻减压管治疗的患者共183例。95例接受深度置管方法置入导管,88例接受传统置管方法(对照组)。对照不同置管方法对急性肠梗阻治疗的效果差异。结果1、深度置管组平均置管深度明显大于传统置管组,P0.01;2、置管完成后24小时,深度置管组引流量明显多于传统置管组,P0.01;术后24、48小时疼痛评分明显低于传统置管组,且48小时腹痛缓解率明显增高,P0.01;置管后排气排便恢复时间及腹部立位平片缓解时间也短于传统置管组,P0.05;置管术后24、48小时,排气排便率及腹部立位平片缓解率均高于传统置管组,P0.05;两组患者需手术解除梗阻率及总体有效率的差异无统计学意义,P0.05;但深度置管组急症手术率降低,P0.05。3、对于黏连性肠梗阻,深度置管方法的治疗效果优于传统置管方法,,P值均0.05;对于癌性及粪石性梗阻,两种置管方法疗效无统计学意义,p0.05。结论相对于传统置管方法,采用深度置管方法可使导管更加接近梗阻部位,充分减压梗阻近端肠管,更有效、更迅速得改善患者症状,降低急症手术率,尤其对于黏连性肠梗阻效果显著。对于癌性肠梗阻及粪石性肠梗阻,两种置管方法的总体疗效相当。
[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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.7

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