• 首都醫(yī)科大學宣武醫(yī)院普外科(北京 100053);

目的  總結(jié)對糞石性小腸梗阻患者的診治經(jīng)驗。
方法  對我院2000~2012年期間收治的45例成人糞石性小腸梗阻患者的病史、X射線表現(xiàn)、CT表現(xiàn)、治療情況等進行回顧性分析。
結(jié)果  本組有22例患者發(fā)病前曾進食柿子、山楂或黑棗,7例有胃部手術史,9例患有糖尿病。39例行腹部CT,其中35例可見小腸擴張與萎陷腸管移行區(qū)橢圓形斑點狀團塊。22例經(jīng)非手術治療緩解,隨訪2~3個月無腸梗阻復發(fā);23例行剖腹探查,其中1例于術后21 d死于急性呼吸窘迫綜合征,其余均治愈。
結(jié)論  進食富含鞣酸食物史、胃部手術史、糖尿病史、典型螺旋CT表現(xiàn)是診斷的關鍵因素,部分患者可經(jīng)保守治療緩解,若保守治療無效,則行手術探查,手術應先試行手法碎石,并全程探查胃腸道以避免多發(fā)糞石殘留。

引用本文: 梁闊,方育,李嘉,李昂,張鈺鵬,劉殿剛,李非. 糞石性小腸梗阻45例臨床分析. 中國普外基礎與臨床雜志, 2013, 20(11): 1292-1294. doi: 復制

1. 胡孔旺, 朱化剛, 耿小平, 等. 粘連性腸梗阻手術指征多因素分析[J]. 中國普外基礎與臨床雜志, 2010, 17(9):939-943.
2. 王甘露, 侍立志, 賀德, 等. 術后粘連性不全性腸梗阻的非手術治療[J]. 中國普外基礎與臨床雜志, 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. 孫忠義, 侯寶華, 施超, 等. 植物糞石性急性小腸梗阻52例分析[J]. 中國實用外科雜志, 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. 陳光文, 宋彬, 吳苾. 腸壁增厚的CT表現(xiàn)及診斷意義[J]. 中國普外基礎與臨床雜志, 2008, 15(12):943-949.
12. 趙興圣, 陳俊香, 周茂義, 等. 64層螺旋CT對糞石性小腸梗阻的診斷[J]. 實用放射學雜志, 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. 陳光文, 宋彬, 吳苾, 等. 多層螺旋CT對非腫瘤性腸壁增厚的應用價值[J]. 中國普外基礎與臨床雜志, 2009, 16(2):164-169.
16. 陳慶永, 方志, 王春友. 成人糞石性急性小腸梗阻患者的早期診治15例[J]. 世界華人消化雜志, 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.
  1. 1. 胡孔旺, 朱化剛, 耿小平, 等. 粘連性腸梗阻手術指征多因素分析[J]. 中國普外基礎與臨床雜志, 2010, 17(9):939-943.
  2. 2. 王甘露, 侍立志, 賀德, 等. 術后粘連性不全性腸梗阻的非手術治療[J]. 中國普外基礎與臨床雜志, 2011, 18(3):286-289.
  3. 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. 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. 5. 孫忠義, 侯寶華, 施超, 等. 植物糞石性急性小腸梗阻52例分析[J]. 中國實用外科雜志, 1999, 19(3):36-37.
  6. 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. 7. Abbas TO. An unusual cause of gastrointestinal obstruction:bezoar[J]. N Z Med J, 2011, 26(2):127-128.
  8. 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. 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. 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. 11. 陳光文, 宋彬, 吳苾. 腸壁增厚的CT表現(xiàn)及診斷意義[J]. 中國普外基礎與臨床雜志, 2008, 15(12):943-949.
  12. 12. 趙興圣, 陳俊香, 周茂義, 等. 64層螺旋CT對糞石性小腸梗阻的診斷[J]. 實用放射學雜志, 2010, 26(11):1613-1616.
  13. 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. 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. 15. 陳光文, 宋彬, 吳苾, 等. 多層螺旋CT對非腫瘤性腸壁增厚的應用價值[J]. 中國普外基礎與臨床雜志, 2009, 16(2):164-169.
  16. 16. 陳慶永, 方志, 王春友. 成人糞石性急性小腸梗阻患者的早期診治15例[J]. 世界華人消化雜志, 2008, 16(25):2903-2905.
  17. 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. 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. 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. 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. 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.