Tondelli P, Müller W, Enderlin F, Hell K, Allgöwer M
Langenbecks Arch Chir. 1975 Jun 9;338(3):169-80. doi: 10.1007/BF01254351.
As an alternative to the extraluminal methods of Noble and Childs-Phillips, the intraluminal splinting of small bowel with the Baker-Tube offers a new possibility in the operative treatment of ileus secondary to adhesions. We report our experiences in 28 patients, using this procedure. An unselected group with severe adhesions was treated with the Baker-Tube, in the majority of the cases at the time of the emergency operation. The immediate postoperative course as well as the results of follow-up examinations 1/2 to 3 1/2 years after the operation are reported. Our experiences can be summarized as follows: 1. Generalized, extensive adhesions are the best indication for the intraluminal splinting. The Baker-Tube should be used with reserve in cases of early and often complicated relaparotomies, especially in the presence of diffuse peritonitis, because of the danger of bowel perforation at the tip of the Tube. 2. The procedure is less time consuming than Noble's operation and in addition allows immediate decompression of the small bowel while advancing the tube. A careful technique is important to prevent complications:--tight closure of the jejunostomy at the insertion point.--fixation of the jejunal loop to the abdominal wall with non absorbable sutures.--in cases of compromised lumen at the insertion point, an entero-entero-anastomosis between afferent and efferent loop should be done. With these precautions, fistulas, detachment of the jejunostoma and stenosis of the jejunal loop can be prevented. 3. Postoperative bowel function is usually rapidly restored, a distinct advantage when compared to the Noble procedure. 4. The rate of complications in our patients is lower than in a reported comparable group with Noble technique. 5. The recurrence rate is much lower than in a reported comparable group with Noble technique. Intraluminal splinting with the Baker-Tube can be recommended as an effective procedure in the treatment of ileus secondary to adhesions.
作为诺布尔（Noble）法和蔡尔兹 - 菲利普斯（Childs - Phillips）法等腔外方法的替代方法，使用贝克管（Baker - Tube）对小肠进行腔内支撑为粘连性肠梗阻的手术治疗提供了一种新的可能性。我们报告了采用此方法治疗28例患者的经验。一组未经挑选的、粘连严重的患者接受了贝克管治疗，大多数情况是在急诊手术时进行的。报告了术后即刻病程以及术后半年至3年半的随访检查结果。我们的经验可总结如下：1. 广泛的粘连是腔内支撑的最佳适应证。对于早期且常伴有复杂再次剖腹手术的病例，尤其是存在弥漫性腹膜炎时，应谨慎使用贝克管，因为存在管尖端肠穿孔的风险。2. 该手术比诺布尔手术耗时少，而且在推进管子时能使小肠立即减压。操作时小心谨慎很重要，以预防并发症：——在插入点紧密闭合空肠造口术。——用不可吸收缝线将空肠袢固定于腹壁。——在插入点管腔受损的情况下，应在输入袢和输出袢之间进行肠 - 肠吻合术。采取这些预防措施可防止瘘管形成、空肠造口脱落和空肠袢狭窄。3. 术后肠道功能通常能迅速恢复，与诺布尔手术相比这是一个明显的优势。4. 我们患者的并发症发生率低于报道的采用诺布尔技术的类似组。5. 复发率远低于报道的采用诺布尔技术的类似组。使用贝克管进行腔内支撑可作为治疗粘连性肠梗阻的有效方法推荐。
