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目的探讨右半结肠切除术后呕吐的病因及防治方法。方法回顾性分析右半结肠切除术后5例长期呕吐患者的临床资料。5例患者均表现幽门梗阻症状,呕吐物中含有胆汁。胃肠造影X平片显示:4例胃无张力,蠕动差;2例1h后少量造影剂进入十二指肠;2例显示十二指肠降部明显扩张,其中的1例更换左侧卧位后可有造影剂通过。1例行CT三维血管重建检查,客观显示明确肠系膜上动脉与腹主动脉之间夹角16度。结果 3例行放置胃管,经禁食、持续胃肠减压和静脉营养支持并配合胃动力药治疗,8-15d后好转。2例通过胃镜将营养管送入空肠上段,肠内营养治疗9-21d后症状好转。结论肠系膜上动脉压迫是右半结肠切除术后发生呕吐的可能原因之一。
Objective To investigate the etiology and prevention and treatment of vomiting after right hemicolectomy. Methods The clinical data of 5 patients with chronic vomiting after right hemicolectomy were retrospectively analyzed. All 5 patients had symptoms of pyloric obstruction and vomit contained bile. Gastrointestinal X-ray film showed: 4 cases of gastric tension, poor peristalsis; 2 cases 1h after a small amount of contrast agent into the duodenum; 2 cases showed significant expansion of the descending part of the duodenum, 1 of them to replace the left lateral After the contrast agent can have passed. A routine CT three-dimensional reconstruction of the vessel, the objective clear that the superior mesenteric artery and the abdominal aorta between 16 degrees. Results The gastric tube was placed in 3 cases. After fasting, continuous decompression and intravenous nutrition support and gastric motility treatment, the improvement was achieved after 8-15 days. 2 cases of feeding tube into the upper jejunum by endoscopy, enteral nutrition treatment 9-21d after symptoms improved. Conclusion Superior mesenteric artery compression is one of the possible causes of vomiting after right hemicolectomy.