| 张玉亮,龚冠闻,江志伟.如何控制术后炎性肠梗阻的“蝴蝶效应” ——以肠瘘术后为例探讨[J].安徽医药,2022,26(3):544-548. |
| 如何控制术后炎性肠梗阻的“蝴蝶效应” ——以肠瘘术后为例探讨 |
| How to control the "butterfly effect" of postoperative inflammatory ileus —A case study of postoperative intestinal fistula |
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| DOI：10.3969/j.issn.1009-6469.2022.03.029 |
| 中文关键词: 肠假性梗阻 肠瘘 手术后并发症 炎性肠梗阻 肠外营养 |
| 英文关键词: Intestinal pseudo-obstruction Intestinal fistula Postoperative complications Inflammatory ileus Parenteral nutrition |
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| 中文摘要: |
| 目的通过分析呈现个体化方案成功治疗 1例肠瘘术后进行性加重炎性肠梗阻的案例，为难治性、复杂性术后炎性肠梗阻提供规范的观察治疗思路。方法对 2020年 11月 3日南京中医药大学附属医院普外科收治的 1例外院常规保守治疗效果不佳术后炎性肠梗阻病人的病例特点、治疗方式和治疗效果进行研究分析。结果 1例因常规保守治疗 43 d失败的术后炎性肠梗阻病人，通过抗炎、小肠梗阻导管肠道减压、肠外营养联合肠内营养治疗等其他对症治疗 25 d后，临床相关指标较治疗前改善显著，肠梗阻导管引流量显著减少、前白蛋白、 CD3+和 CD4+T淋巴细胞指标明显升高、超敏 C反应蛋白( hs-CRP)、白介素-6(IL-6)明显降低、腹部 CT检查结果明显改善，最终痊愈出院。结论降低炎症反应、改善营养功能、及时针对性肠道减压是治疗术后炎性肠梗阻关键措施。 |
| 英文摘要: |
| Objective To provide a standard observation and treatment for refractory and complicated postoperative inflammatory ileus by presenting and analyzing a case of successful individualized treatment for progressive exacerbation of postoperative inflammatory ileus.Methods A patient with postoperative inflammatory ileus, who had poor efficacy of conventional conservative treatment andthen was admitted to Department of General Surgery of The Affiliated Hospital of Nanjing University of Chinese Medicine on November3, 2020, was investigated and analyzed in terms of case characteristics, treatment and efficacy.Results The postoperative inflammatory ileus patient, who experienced failure in 43 d conventional conservative treatment, achieved significantly better results of clinical indexes through anti-inflammatory treatment, catheter intestinal decompression for small intestinal obstruction, and parenteral nutritionin combination with enteral nutrition therapy for 25 d. The volume of drainage was significantly reduced, the level of prealbumin, CD3+ and CD4 + T lymphocyte counts increased significantly, and the levels of hypersensitive C-reactive protein (hs-CRP) and interleukin 6 (IL-6) decreased obviously. The results of abdominal CT examination significantly improved, and the patient eventually recovered andwas discharged from hospital.Conclusion Reduction in inflammatory response, improvement in nutritional function and timely targeted intestinal decompression are the key measures for the treatment of postoperative inflammatory ileus. |
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