目的 總結(jié)對糞石性小腸梗阻患者的診治經(jīng)驗。
方法 對我院2000~2012年期間收治的45例成人糞石性小腸梗阻患者的病史、X射線表現(xiàn)、CT表現(xiàn)、治療情況等進行回顧性分析。
結(jié)果 本組有22例患者發(fā)病前曾進食柿子、山楂或黑棗,7例有胃部手術(shù)史,9例患有糖尿病。39例行腹部CT,其中35例可見小腸擴張與萎陷腸管移行區(qū)橢圓形斑點狀團塊。22例經(jīng)非手術(shù)治療緩解,隨訪2~3個月無腸梗阻復(fù)發(fā);23例行剖腹探查,其中1例于術(shù)后21 d死于急性呼吸窘迫綜合征,其余均治愈。
結(jié)論 進食富含鞣酸食物史、胃部手術(shù)史、糖尿病史、典型螺旋CT表現(xiàn)是診斷的關(guān)鍵因素,部分患者可經(jīng)保守治療緩解,若保守治療無效,則行手術(shù)探查,手術(shù)應(yīng)先試行手法碎石,并全程探查胃腸道以避免多發(fā)糞石殘留。
引用本文: 梁闊,方育,李嘉,李昂,張鈺鵬,劉殿剛,李非. 糞石性小腸梗阻45例臨床分析. 中國普外基礎(chǔ)與臨床雜志, 2013, 20(11): 1292-1294. doi: 復(fù)制
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1. | 胡孔旺, 朱化剛, 耿小平, 等. 粘連性腸梗阻手術(shù)指征多因素分析[J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(9):939-943. |
2. | 王甘露, 侍立志, 賀德, 等. 術(shù)后粘連性不全性腸梗阻的非手術(shù)治療[J]. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(3):286-289. |
3. | Ho TW, Koh DC. Small-bowel obstruction secondary to bezoar impaction:a diagnostic dilemma[J]. World J Surg, 2007, 31(5):1072-1078. |
4. | Bedioui H, Daghfous A, Ayadi M, et al. A report of 15 cases of small-bowel obstruction secondary to phytobezoars:predisposing factors and diagnostic difficulties[J]. Gastroenterol Clin Biol, 2008, 32(6-7):596-600. |
5. | 孫忠義, 侯寶華, 施超, 等. 植物糞石性急性小腸梗阻52例分析[J]. 中國實用外科雜志, 1999, 19(3):36-37. |
6. | Kement M, Ozlem N, Colak E, et al. Synergistic effect of multiple predisposing risk factors on the development of bezoars[J]. World J Gastroenterol, 2012, 18(9):960-964. |
7. | Abbas TO. An unusual cause of gastrointestinal obstruction:bezoar[J]. N Z Med J, 2011, 26(2):127-128. |
8. | Koktener A, Dilmen G, Turkay C, et al. Small bowel obstructioncaused by phytobezoar and associated with vitamin B12 deficiency[J]. South Med J, 2006, 99(9):1013-1014. |
9. | Kim Y, Park BJ, Kim MJ, et al. Biliary phytobezoar resulting in intestinal obstruction[J]. World J Gastroenterol, 2013, 19(1):133-136. |
10. | de Toledo AP, Rodrigues FH, Rodrigues MR, et al. Diospyro-bezoar as a cause of small bowel obstruction[J]. Case Rep Gastroenterol, 2012, 6(3):596-603. |
11. | 陳光文, 宋彬, 吳苾. 腸壁增厚的CT表現(xiàn)及診斷意義[J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(12):943-949. |
12. | 趙興圣, 陳俊香, 周茂義, 等. 64層螺旋CT對糞石性小腸梗阻的診斷[J]. 實用放射學(xué)雜志, 2010, 26(11):1613-1616. |
13. | Liou CH, Yu CY, Lin CC, et al. CT diagnosis of small bowel obstruction due to phytobezoar[J]. J Formos Med Assoc, 2003, 102(9):620-624. |
14. | Yildirim T, Yildirim S, Barutcu O, et al. Small bowel obstruction due to phytobezoar:CT diagnosis[J]. Eur Radiol, 2002, 12(11):2659-2661. |
15. | 陳光文, 宋彬, 吳苾, 等. 多層螺旋CT對非腫瘤性腸壁增厚的應(yīng)用價值[J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(2):164-169. |
16. | 陳慶永, 方志, 王春友. 成人糞石性急性小腸梗阻患者的早期診治15例[J]. 世界華人消化雜志, 2008, 16(25):2903-2905. |
17. | Tayeb M, Khan FM, Rauf F, et al. Phytobezoar in a jejunaldiverticulum as a cause of small bowel obstruction:a case report[J]. J Med Case Reports, 2011, 5:482. |
18. | Ganpathi IS, Cheah WK. Laparoscopic-assisted management of small bowel obstruction due to phytobezoar[J]. Surg Laparosc Endosc Percutan Tech, 2005, 15(1):30-32. |
19. | Kan JY, Huang TJ, Heish JS. Laparoscopy-assisted management of jejunal bezoar obstruction[J]. Surg Laparosc Endosc PercutanTech, 2005, 15(5):297-298. |
20. | Ghosheh B, Salameh JR. Laparoscopic approach to acute small bowel obstruction:review of 1 061 cases[J]. Surg Endosc, 2007, 21(11):1945-1949. |
21. | de Menezes Ettinger JE, Silva Reis JM, de Souza EL, et al. Laparoscopic management of intestinal obstruction due to phytobezoar[J]. JSLS, 2007, 11(1):168-171. |
- 1. 胡孔旺, 朱化剛, 耿小平, 等. 粘連性腸梗阻手術(shù)指征多因素分析[J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(9):939-943.
- 2. 王甘露, 侍立志, 賀德, 等. 術(shù)后粘連性不全性腸梗阻的非手術(shù)治療[J]. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(3):286-289.
- 3. Ho TW, Koh DC. Small-bowel obstruction secondary to bezoar impaction:a diagnostic dilemma[J]. World J Surg, 2007, 31(5):1072-1078.
- 4. Bedioui H, Daghfous A, Ayadi M, et al. A report of 15 cases of small-bowel obstruction secondary to phytobezoars:predisposing factors and diagnostic difficulties[J]. Gastroenterol Clin Biol, 2008, 32(6-7):596-600.
- 5. 孫忠義, 侯寶華, 施超, 等. 植物糞石性急性小腸梗阻52例分析[J]. 中國實用外科雜志, 1999, 19(3):36-37.
- 6. Kement M, Ozlem N, Colak E, et al. Synergistic effect of multiple predisposing risk factors on the development of bezoars[J]. World J Gastroenterol, 2012, 18(9):960-964.
- 7. Abbas TO. An unusual cause of gastrointestinal obstruction:bezoar[J]. N Z Med J, 2011, 26(2):127-128.
- 8. Koktener A, Dilmen G, Turkay C, et al. Small bowel obstructioncaused by phytobezoar and associated with vitamin B12 deficiency[J]. South Med J, 2006, 99(9):1013-1014.
- 9. Kim Y, Park BJ, Kim MJ, et al. Biliary phytobezoar resulting in intestinal obstruction[J]. World J Gastroenterol, 2013, 19(1):133-136.
- 10. de Toledo AP, Rodrigues FH, Rodrigues MR, et al. Diospyro-bezoar as a cause of small bowel obstruction[J]. Case Rep Gastroenterol, 2012, 6(3):596-603.
- 11. 陳光文, 宋彬, 吳苾. 腸壁增厚的CT表現(xiàn)及診斷意義[J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(12):943-949.
- 12. 趙興圣, 陳俊香, 周茂義, 等. 64層螺旋CT對糞石性小腸梗阻的診斷[J]. 實用放射學(xué)雜志, 2010, 26(11):1613-1616.
- 13. Liou CH, Yu CY, Lin CC, et al. CT diagnosis of small bowel obstruction due to phytobezoar[J]. J Formos Med Assoc, 2003, 102(9):620-624.
- 14. Yildirim T, Yildirim S, Barutcu O, et al. Small bowel obstruction due to phytobezoar:CT diagnosis[J]. Eur Radiol, 2002, 12(11):2659-2661.
- 15. 陳光文, 宋彬, 吳苾, 等. 多層螺旋CT對非腫瘤性腸壁增厚的應(yīng)用價值[J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(2):164-169.
- 16. 陳慶永, 方志, 王春友. 成人糞石性急性小腸梗阻患者的早期診治15例[J]. 世界華人消化雜志, 2008, 16(25):2903-2905.
- 17. Tayeb M, Khan FM, Rauf F, et al. Phytobezoar in a jejunaldiverticulum as a cause of small bowel obstruction:a case report[J]. J Med Case Reports, 2011, 5:482.
- 18. Ganpathi IS, Cheah WK. Laparoscopic-assisted management of small bowel obstruction due to phytobezoar[J]. Surg Laparosc Endosc Percutan Tech, 2005, 15(1):30-32.
- 19. Kan JY, Huang TJ, Heish JS. Laparoscopy-assisted management of jejunal bezoar obstruction[J]. Surg Laparosc Endosc PercutanTech, 2005, 15(5):297-298.
- 20. Ghosheh B, Salameh JR. Laparoscopic approach to acute small bowel obstruction:review of 1 061 cases[J]. Surg Endosc, 2007, 21(11):1945-1949.
- 21. de Menezes Ettinger JE, Silva Reis JM, de Souza EL, et al. Laparoscopic management of intestinal obstruction due to phytobezoar[J]. JSLS, 2007, 11(1):168-171.