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相關文獻
- Gastrointestinal Obstruction Caused by Bezoars
- Phytobezoar-Induced Small Bowel Obstruction: Report of a Case
- Duodenal Obstruction Secondary to Phytobezoar in a Child: Surgically Removed Via Gastrotomy
- Sonographic Appearance of a Gastric Bezoar on Gastric Water Loading: Report of a Case
- Sonographic Detection of Small Intestinal Phytobezoars as the Cause of Ileus: Report of Two Cases
- Small Intestine Bezoar: Computed Tomography Appearance
- Mechanical Obstruction of Bowel and Megacolon Caused by Fecal Impaction
- Small Bowel Obstruction due to Trichobezoar
- Bezoars in Children: Report of Four Cases
- Gastrointestinal Phytobezoar in Children
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題 名 | Gastrointestinal Obstruction Caused by Bezoars=糞石引起之胃腸阻塞 |
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作 者 | 陳楷模; 王世名; 陳顯榮; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 18:2 1985.06[民74.06] |
頁 次 | 頁139-148 |
分類號 | 416.24 |
關鍵詞 | 胃腸阻塞; 糞石; |
語 文 | 英文(English) |
中文摘要 | 糞石仍指異物崁塞於腸胃道內而言。可分為四大類:(1)毛糞石:由毛髮組成。(2)植物糞石:由蔬菜與水果之纖維組成。(3)毛植物糞石,由毛髮、蔬菜、水果之纖維組成。(4)凝結糞石:由焦油、蟲漆、砂石、樹脂等所組成。 胃切除後或迷走神經切除後之病患所引起之糞石病例日愈增多,已成為很常見且很嚴重的臨床問題。傳統上是以外科手術去除糞石,最近使用內視鏡碎裂術或酵索消化術或兩種方法合併使用以去除胃腸內糞石文獻上已有許多報告,並有成功的病例報告。糞石最常見的合併症是胃腸阻塞。其他常見的併發症有胃腸潰瘍、出血、穿孔與腹膜炎等。 過去29年間,在台大外科治療過之2091例胃腸阻塞中,共發現有27例是由糞石所引起的。其發生率為1.3%。其中男20名女7名,男女比率為2.9。年齡分佈由2歲至84歲,平均年齡為39.2歲。在這些病例中,11例(40.7%)以前會經做過胃手術;包括6例胃次全切除術,4例迷走神經切斷術加幽門成形術,1倒迷走神經切斷術加胃空腸吻合術 。 所有病患都有胃腸阻蜜之症候包括腹痛、腹脹、噁心、嘔吐等。症候期從一天到三週,平均為3.3天。病患有胃腸阻塞之症候時,即需懷疑是否由糞石所引起之胃腸阻塞,尤其是以前曾經做過胃手術之病患或牙齒不全的老人,更應該考慮糞石引起腸阻塞之可能性。X光檢查是最有效的診斷方法,本報告之術前正確之診斷率僅14.8%。 一般所接受之治療方法為剖腹探察。在本報告中有15例(55.6%)做腸切開術以摘出糞石,9例(33.3%)可將糞石用手擠到結腸內,1例做胃次全切除術,因有一巨大胃潰瘍同時存在於糞石旁。1例做結腸切開術以除去橫行結腸中之鋇糞石,1例因有小腸狹窄同時做小腸小段切除術。 有25例為植物性糞石,1例為乳糞石,1列為鋇糞石,本報告中沒發現有毛糞石。最常見糞石阻塞於廻腸內(23例, 85.2%),2例在胃內,空腸與結腸各1例。糞石之直徑通常為三到四公分,最大者為九公分。有九例糞石為多發性者。 本系列之治療結果,無死亡病例,但罹病率高達29.6%。外科手術仍是糞石引起之胃腸阻塞目前最佳之治療方法。 |
英文摘要 | In the past 29 years, 27 cases of bezoar caused gastrointestinal (G-I) obstruction were found among 2091 cases of G-I obstruction, or an incidence of 1.3%. The patients studied included 20 men and seven women, with a male to female ratio of 2.9. The ages ranged from two to 84 years, with the mean age 39.2 years. Eleven patients (40.7%) had had previous gastric procedures including six subtotal gastrectomies, four vagotomies plus pyloroplasty, and one vagotomy plus gastrojejunostomy. All patients presented with G-I obstruction manifested as abdominal pain, distension, nausea and vomiting. The duration of symptomsvaried from one day to three weeks with an average duration of 3.3 days. The possibility of bezoar should be investigated in patients with symptoms of G-I obstruction, especially when there have been previous gastric surgical procedures or the patient is edentulous. X-ray examination is the most effective method to diagnose this disease. The accuracy of diagnosis was only 14.8%. It is generally accepted that the treatment of choice is laparotomy. In this series, 15 patients (55.6%) required enterotomy for bezoar evacuation; nine (33.3%) were able to milk bezoars to the colon; one, with a large gastric ulcer in addition to gastric bezoar, received a subtotal gastrectomy; one received segmental resection of the intestine; and one received colotomy for removal of bezoar from the transverse colon. There were 25 phytobezoar, one lactobezoar and one concretion (barium bezoar). No trichobezoar was found in this series. Most bezoars impacted in the ileum (23 cases, 35.2%). Two bezoar were found in the stomach, one in the jejunum and the other in the collon. Most of the bezoars measured 3 to 4cm in diameter, with the largest 9 cm in diameter. Multiple bezoars occurred in eight patients. There was no mortality, but the morbidity rate (29.6%) was rather high. |
本系統中英文摘要資訊取自各篇刊載內容。