DR引导下肠梗阻导管治疗腹腔镜胃十二指肠穿孔修补术后瘘

摘要

Objective To evaluate the application of ileus tube with digital radiography (DR) guidance in the treatment of gastroduodenal fistula after laparoscopic gastroduodenal ulcer perforation repair.Methods Admitted to Guangdong Second Provincial General Hospital from January 2006 to January 2013,25 patients with gastroduodenal fistula after laparoscopic gastroduodenal ulcer perforation repair were selected in the study,and the clinical data of the selected patients were analyzed retrospectively.Treatment options in the study included conventional conservative treatment and ileus tube placement combined with enteral parenteral nutrition therapy under DR guidance.The primary outcomes after treatment included the time needed for white blood cell count,C-reactive protein,procalcitonin-related infection indexes to return to the normal levels;the recovery time of bowel function;albumin level;the healing time of gastrointestinal fistula;peritoneal drainage;complication;hospital cost;hospital stay and mortality.Results Twenty-two patients were cured by non-surgical treatment and 3 patients received earlystage adjuvant surgery.For 12 patients treated by ileus tube placement combined with enteral parenteral nutrition therapy,white blood cell count,C-reactive protein,procalcitonin-related infection indexes took (3.3±1.1),(5.1±0.8),(4.3±1.0) d,respectively,to retum to the normal levels,and the recovery time of bowel function was (2.1±0.7) d;during hospitalization,the albumin level was (35.2 ± 3.0) g/L,and peritoneal drainage was (182±20) mL/d;the healing time of gastrointestinal fistula was (10.3± 1.5) d.The above-mentioned indexes of 12 patients were superior to those in conventional conservative treatment group.The long-term follow-up showed that no differences were found in long-term complications between two groups.Conclusion Under DR guidance,ileus tube placement combined with enteral parenteral nutrition therapy has a good therapeutic effect on gastroduodenal fistula after laparoscopic gastroduodenal ulcer perforation repair,with clinical value.%目的:评估在直接数字平板X线成像系统(DR)引导下应用肠梗阻导管在腹腔镜胃十二指肠穿孔修补术后瘘治疗中的价值.方法:回顾性分析广东省第二人民医院2006年1月至2013年1月进行腹腔镜胃十二指肠修补术后并发胃十二指肠瘘的25例患者的临床资料.治疗方案包括常规保守治疗和DR引导下置入肠梗阻导管联合肠内肠外营养治疗.主要观察指标为两组治疗后白细胞计数恢复正常时间、C反应蛋白恢复正常时间、降钙素原相关感染指标下降至正常时间、肠道功能恢复时间、白蛋白水平、胃肠瘘愈合时间、腹腔引流量、并发症、住院费用、住院时间及死亡率等.结果:25例胃十二指肠瘘患者均治愈,非手术治疗治愈22人,早期辅助性手术3人.12例患者采用置入肠梗阻导管联合肠内肠外营养治疗,白细胞计数、C反应蛋白、降钙素原相关感染指标下降至正常的时间分别为(3.3±1.1)、(5.l±0.8)、(4.3士1.0)d,肠道功能恢复时间(2.1±0.7)d,白蛋白水平住院期间平均为(35.2±3.0) g/L,腹腔引流量为(182±20) mL/d,胃肠瘘愈合时间为(10.3士1.5)d,上述指标优于常规保守治疗.长期随访显示远期并发症两组无差异.结论:DR引导下置入肠梗阻导管联合肠内肠外营养对腹腔镜胃十二指肠修补术后瘘治疗效果较好,具有良好的临床应用价值.