-
摘要: 目的：总结急性肠扭转的早期诊断及治疗的经验。方法：对我院近5年中的62例急性肠扭转患者的临床表现、检查及治疗方法回顾性分析，探讨肠扭转的早期诊断及治疗问题。结果：51例肠扭转患者经螺旋CT检查确诊，8例经行稀钡灌肠确诊，3例经腹腔镜探查确诊；52例行手术治疗（其中35例系腹腔镜下手术），2例经稀钡灌肠时复位，3例肠镜下复位成功，5例保守治疗好转。结论：早期在临床出现"症征分离"性腹痛时，立即行螺旋CT检查，但检查阴性征象不能轻易排除本病，必要时行腹腔镜探查。对于有急性期肠扭转超过180°以上的患者建议及时早期手术（包括腹腔镜下复位），对于乙状结肠扭转患者，如果症状较轻，可考虑肠镜下或稀钡灌肠试复位，如保守治疗失败或出现肠坏死症状时应及早进行手术。Abstract: Objective: Summarize the acute volvulus of early diagnosis and treatment experience.Method: The clinical data of 62 cases with acute volvulus admitted in our hospital during the last five years were retrospectively analyzed, including clinical manifestations,inspection and treatment methods,the early diagnosis and treatment of volvulus were disscussed.Result: 51 casesvolvulus patients were diagnosed by MSCT examination,8 cases were diagnosed with dilute barium enema,3 cases were diagnosed by laparoscopic exploration diagnosis;52 cases underwent routine surgical treatment(35 cases of laparoscopic surgery department),2 cases restored flowing dilute barium enema,3 cases restored by colonoscopy,5 cases get better by conservative treatment.Conclusion: Spiral CT should be carried on immediately when "diseas sign separation" abdominal pain appears early,,but the disease can not be easily ruled out when we got negative signs, laparoscopic exploration is necessary. For pataients wiht acute volvulus exceed 180 °, early surgery is recommended (including laparoscopic reset), For patients with sigmoid torsional, if symptoms are mild, colonoscopy or dilute barium enema reset may be considered,if conservative treatment fails or bowel necrosis symptoms appears, surgery should be taken as soon as possible.
-
Key words:
- acute volvulus /
- early diagnosis /
- treatment
-
-
[1] 慕容洋洋, 江山, 苏阳.急性肠扭转的临床诊断与治疗[J].中国实用外科杂志, 2006, 26(5):292-293.
[2] 吴阶平, 裘法祖, 黄家驷.外科学[M].6版.北京:人民卫生出版社, 2002:1154-1156.
[3] IANNELLI A, FABIANI P, DAHMAN M, et al.Small bowel volvulus resulting from a congenital band treated iatroscopically[J].Surg Endosc, 2009, 16:538-538.
[4] CHOU C K, WU R H, MA K C W, et al.Clinical significance of poor CT enhancement of thickened small bowel wall in patients with acute abdominal pain[J].AJR, 2010, 186:491-498.
[5] 蒋清, 罗江山, 刘寒湘, 等.多层螺旋CT对肠扭转的优势探讨[J].中国中医药现代远程教育, 2012, 10(7):99-100.
[6] 吴在德, 吴肇汉.外科学[M].6版.北京:人民卫生出版社, 2005:482-483.
[7] 华子, 文武, 杨沅.肠扭转的诊断治疗与临床分析[J].普外临床, 2006, 21(4):247-248.
[8] 黄志强, 黎鳌, 张肇样.外科手术学[M].3版.北京:人民卫生出版社, 2002:812-817.
[9] 龙子, 满媛, 文杰.结肠扭转的诊治与临床研究[J].中国普通外科杂志, 2005, 23(1):62-63.
[10] 杨雪菲, 李明伟, 钟克力, 等.腹腔镜探查在胃肠外科急诊中的应用[J].中华胃肠外科杂志, 2009, 12(6):634-635.
-
计量
- 文章访问数: 65
- PDF下载数: 295
- 施引文献: 0
下载: