目的 总结对粪石性小肠梗阻患者的诊治经验。
方法 对我院2000~2012年期间收治的45例成人粪石性小肠梗阻患者的病史、X射线表现、CT表现、治疗情况等进行回顾性分析。
结果 本组有22例患者发病前曾进食柿子、山楂或黑枣,7例有胃部手术史,9例患有糖尿病。39例行腹部CT,其中35例可见小肠扩张与萎陷肠管移行区椭圆形斑点状团块。22例经非手术治疗缓解,随访2~3个月无肠梗阻复发;23例行剖腹探查,其中1例于术后21 d死于急性呼吸窘迫综合征,其余均治愈。
结论 进食富含鞣酸食物史、胃部手术史、糖尿病史、典型螺旋CT表现是诊断的关键因素,部分患者可经保守治疗缓解,若保守治疗无效,则行手术探查,手术应先试行手法碎石,并全程探查胃肠道以避免多发粪石残留。
Citation:
梁阔,方育,李嘉,李昂,张钰鹏,刘殿刚,李非. Clinical Analysis of Diagnosis and Treatment for 45 Cases ofmall Bowel Obstruction Due to Bezoars. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(11): 1292-1294. doi:
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1. |
胡孔旺, 朱化刚, 耿小平, 等. 粘连性肠梗阻手术指征多因素分析[J]. 中国普外基础与临床杂志, 2010, 17(9):939-943.
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王甘露, 侍立志, 贺德, 等. 术后粘连性不全性肠梗阻的非手术治疗[J]. 中国普外基础与临床杂志, 2011, 18(3):286-289.
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Ho TW, Koh DC. Small-bowel obstruction secondary to bezoar impaction:a diagnostic dilemma[J]. World J Surg, 2007, 31(5):1072-1078.
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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.
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5. |
孙忠义, 侯宝华, 施超, 等. 植物粪石性急性小肠梗阻52例分析[J]. 中国实用外科杂志, 1999, 19(3):36-37.
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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.
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7. |
Abbas TO. An unusual cause of gastrointestinal obstruction:bezoar[J]. N Z Med J, 2011, 26(2):127-128.
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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.
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9. |
Kim Y, Park BJ, Kim MJ, et al. Biliary phytobezoar resulting in intestinal obstruction[J]. World J Gastroenterol, 2013, 19(1):133-136.
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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.
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陈光文, 宋彬, 吴苾. 肠壁增厚的CT表现及诊断意义[J]. 中国普外基础与临床杂志, 2008, 15(12):943-949.
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赵兴圣, 陈俊香, 周茂义, 等. 64层螺旋CT对粪石性小肠梗阻的诊断[J]. 实用放射学杂志, 2010, 26(11):1613-1616.
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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.
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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.
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15. |
陈光文, 宋彬, 吴苾, 等. 多层螺旋CT对非肿瘤性肠壁增厚的应用价值[J]. 中国普外基础与临床杂志, 2009, 16(2):164-169.
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陈庆永, 方志, 王春友. 成人粪石性急性小肠梗阻患者的早期诊治15例[J]. 世界华人消化杂志, 2008, 16(25):2903-2905.
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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.
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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.
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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, 朱化刚, 耿小平, 等. 粘连性肠梗阻手术指征多因素分析[J]. 中国普外基础与临床杂志, 2010, 17(9):939-943.
- 2. 王甘露, 侍立志, 贺德, 等. 术后粘连性不全性肠梗阻的非手术治疗[J]. 中国普外基础与临床杂志, 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. 孙忠义, 侯宝华, 施超, 等. 植物粪石性急性小肠梗阻52例分析[J]. 中国实用外科杂志, 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. 陈光文, 宋彬, 吴苾. 肠壁增厚的CT表现及诊断意义[J]. 中国普外基础与临床杂志, 2008, 15(12):943-949.
- 12. 赵兴圣, 陈俊香, 周茂义, 等. 64层螺旋CT对粪石性小肠梗阻的诊断[J]. 实用放射学杂志, 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. 陈光文, 宋彬, 吴苾, 等. 多层螺旋CT对非肿瘤性肠壁增厚的应用价值[J]. 中国普外基础与临床杂志, 2009, 16(2):164-169.
- 16. 陈庆永, 方志, 王春友. 成人粪石性急性小肠梗阻患者的早期诊治15例[J]. 世界华人消化杂志, 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.