经鼻肠梗阻导管联合手术治疗恶性肠梗阻（附1例报告）

doi:10.16139/j.1007-9610.2024.06.11

摘要/Abstract

摘要：

恶性肠梗阻(MBO)是晚期腹盆腔恶性肿瘤的常见并发症，总体预后差，严重影响肿瘤晚期病人的生活质量。其发展机制因素多，无标准化治疗方案，大多数MBO病人不适合手术。化疗及全肠外营养的应用也仍存在争议。最佳治疗仍为支持治疗，包括药物治疗和胃肠减压等。本病例确诊MBO 5天入院，入院后即留置经鼻肠梗阻导管，经保守治疗症状部分缓解，复查腹部CT提示存在闭襻梗阻。遂行手术探查，术中见近端小肠内导管支撑良好且减压效果明显，但由于肿瘤原因末端回肠呈节段性闭襻梗阻，结肠闭襻梗阻，遂行结肠+小肠造口术。术后恢复顺利出院。本病例通过经鼻肠梗阻导管联合手术治疗，提高病情判断的准确性，增加手术的可行性及安全性，达到预期治疗目的，提供MBO潜在的治疗方案。

关键词: 恶性肠梗阻, 肠梗阻导管, 手术, 保守治疗

Abstract:

Malignant bowel obstruction(MBO) is a common complication of advanced ventral-pelvic tumors, with poor overall prognosis and seriously affecting the quality of life of these patients. Numerous factors are involved in the pathogenesis of MBO and there is no standard treatment. Most MBO patients were not suitable for surgery. The use of chemotherapy and total parenteral nutrition(TPN) is also controversial. The best treatment is still supportive treatment, including drug treatment and gastrointestinal decompression. Here we reported a case diagnosed as MBO. Transnasal ileus cathete was inserted immediately when hospitalizated after diagnosed 5 days. The symptom was partial relieved after conservative treatment. The abdomen CT scan suggested the sign of closed-loop obstruction. Then, an exploratory laparotomy was performed and found proximal small intestine obviously decompressed with transnasal ileus catheter. However, the tumor caused the closed-loop obstruction of terminal ileum and colon, then the transverse colostomy and terminal ileostomy were performed. After treatment, the patient recovered and was discharged from the hospital. In conclusion, the use of transnasal ileus catheter combined with surgery in MBO, could improve the accuracy of condition judgment, increase the feasibility and safety of surgery, and achieved the goals of treatment expected, and might be a potential treatment regimen for MBO.

Key words: Malignant bowel obstruction, Transnasal ileus catheter, Surgery, Conservative treatment

中图分类号:

R574
R735.35

金益峰, 陈诗雨, 崔荣, 夏玉峰, 周勇. 经鼻肠梗阻导管联合手术治疗恶性肠梗阻（附1例报告）[J]. 外科理论与实践, 2024, 29(06): 523-528.

JIN Yifeng, CHEN Shiyu, CUI Rong, XIA Yufeng, ZHOU Yong. Use of transnasal ileus catheter combined with surgery in malignant bowel obstruction：one case report[J]. Journal of Surgery Concepts & Practice, 2024, 29(06): 523-528.

图/表 4

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