Search

卵黄管未闭、内疝形成导致肠梗阻1例报告

患者，男，27岁，因腹痛、腹胀，停止从肛门排便、排气2天伴恶心、呕吐入院。查体： 体温37.0℃，急性痛苦病容，心、肺无异常发现； 腹平坦，未见肠型及蠕动波，未扪及肿块，脐周有轻压痛及局部肌紧张，但无反跳痛、移动性浊音及震水音，肠鸣音1～2次/min，偶有高调肠鸣音，未闻及气过水声。腹部X线透视示一组小肠可见巨大液平面。诊断： 高位肠梗阻。入院后经禁食、持续胃肠减压、补液、抗炎及对症治疗24小时，但症状仍逐渐加重。体温37.8℃，上腹部膨隆，叩诊呈鼓音，腹透示左上腹有4个巨大液平面。遂在全麻下行急诊剖腹探查术。术中见腹腔内有约400 ml淡红色清亮渗液，有约1 m长的空肠及系膜呈“W”形顺时针疝入由未闭之卵黄管形成的“C”形回肠憩室疝环（约300°），造成肠管完全性闭绊性梗阻。该段肠管壁水肿、瘀血，呈暗红色，有散在瘀斑，肠腔扩张显著，肠管蠕动明显减弱。行肠减压术，待该肠段松弛后，在距腹壁约3.0 cm处将卵黄管盲端切断，缝扎断端，从根部切断憩室，全层加浆肌层缝合修补回肠侧壁，检查可通过一指后，于肠管修补处近端约10 cm处放置菌形造瘘管。再次检查梗阻部位，见肠管蠕动良好，血运显著改善。温盐水反复冲洗腹腔，于盆腔置血浆引流管。术后诊断： ①高位肠梗阻； ②内疝； ③卵黄管未致回肠憩室。术后行抗感染、止血、对症及支持治疗，痊愈出院。

THE ROLE OF OCTREOTIDE IN THE TREATMENT OF SEVERE ACUTE PANCREATITIS

To evaluate the role of octreotide in the treatment of severe acute pancreatitis (SAP). Seventy-six patients were divided into two groups (octreotide group, n＝38, control group, n＝38). All patients were treated by the same conservative regime. The octreotide group received octreotide. Results: The abdominal symptoms and signs, WBC count, serum amylase level, and volume of ascites were more effective controlled, with fewer complications occurred in octreotide group. Conclusion: Octreotide has a beneficial effect on the treatment of SAP, but the mechanism will be further investigated.

奥曲肽治疗胰瘘的临床观察12例报告

奥曲肽治疗胆瘘7例报告