Truong S, Willis S, Riesener K P, Seelig M, Bötjer A, Schumpelick V
Chirurgische Universitätsklinik und Poliklinik, Klinikum, RWTH Aachen.
Langenbecks Arch Chir. 1997;382(4):216-21. doi: 10.1007/BF02391869.
For determination of the efficacy of intraluminal bowel decompression by an endoscopically placed Dennis tube, 174 patients with paralytic ileus or different kinds of partial small bowel obstruction were reviewed retrospectively. There were 66 cases (37.9%) of early postoperative ileus (A), 27 (15.5%) of late postoperative ileus (B), 38 (21.8%) of paralytic ileus (C), 31 (17.8%) with obstruction due to advanced intraabdominal tumors (D), and 12 (6.8%) of obstructive ileus caused by inflammatory stenosis of the small bowel in Crohn's disease (E). Successful endoscopic placement of the intestinal tube was achieved in 97.2% of patients. Placement of the tube was impossible in 5 cases. A total of 95 patients (54.6%) were successfully managed by long intestinal tube decompression. Success rates for the individual groups were 71.2% (A), 18.5% (B), 86.8% (C), 16.1% (D), and 41.7% (E). Some 75 patients (43.1%) had to be operated on because of insufficient conservative therapy. Four patients with advanced intraabdominal tumors died during the treatment with the intestinal tube; 13 patients died postoperatively. There was no tube-related mortality, but tube-related complications occurred in 6.9%. We conclude that intraluminal intestinal tube decompression after endoscopic placement provides a therapeutic tool with a concomitant low complication and high success rate in paralytic and early postoperative ileus.
为了确定经内镜放置丹尼斯管进行肠腔内减压的疗效,我们回顾性分析了174例麻痹性肠梗阻或不同类型的部分性小肠梗阻患者。其中术后早期肠梗阻(A组)66例(37.9%),术后晚期肠梗阻(B组)27例(15.5%),麻痹性肠梗阻(C组)38例(21.8%),腹腔晚期肿瘤所致肠梗阻(D组)31例(17.8%),克罗恩病小肠炎性狭窄所致梗阻性肠梗阻(E组)12例(6.8%)。97.2%的患者成功通过内镜放置了肠管。5例患者无法放置肠管。共有95例患者(54.6%)通过长肠管减压成功治疗。各亚组的成功率分别为71.2%(A组)、18.5%(B组)、86.8%(C组)、16.1%(D组)和41.7%(E组)。约75例患者(43.1%)因保守治疗效果不佳而接受了手术。4例腹腔晚期肿瘤患者在肠管治疗期间死亡;13例患者术后死亡。无与肠管相关的死亡,但肠管相关并发症发生率为6.9%。我们得出结论,内镜放置后肠腔内肠管减压为麻痹性肠梗阻和术后早期肠梗阻提供了一种并发症发生率低且成功率高的治疗手段。