中医药研究论丛

264.5 电针治疗肠造口关闭手术後肠阻塞之 病例报告

 TJ TCM.26(4) : 55-71, 2023

DOI : 10.6516/TJTCM.202309_26(4).0005
 
电针治疗肠造口关闭手术後肠阻塞之 病例报告
Electroacupuncture Improves Postoperative
Ileus in Patient Underwent Loop Ileostomy
Closure: A Case Report
唐萱庭 1 黄明正 1,*
1 中国医药大学附设医院中医部,台中,台湾
【摘要】
术後肠阻塞是肠造口关闭手术後最常见且重要的并发症,影响病患的肠胃道功能,产生噁心呕吐、腹胀、腹痛等症状,扰乱术後的恢复情形,甚至会延长住院天数而造成负担。目前临床上针对术後肠阻塞仍以保守治疗与支持性疗法为主,透过限制饮食、鼻胃管肠道减压、周边营养支持等方式,让病患肠胃道妥善休息後自行恢复蠕动,然而肠胃道动力恢复的时间却难以掌控。 本病例为69岁男性患者,半年前因肛门反覆出血而诊断出大肠直肠癌,经 过同步化学放射治疗与手术切除肿瘤後,於110年7月6日入院接受回肠造口关 闭手术,术後无法解便,腹胀严重,故会诊中医针灸协助治疗。病患於前三次 针刺治疗後,稍可自行排便,但仍腹胀,呕吐多次而放置鼻胃管引流减压,之後我们改以电针治疗的当天,病患腹胀大减,排便量增加,且於大肠镜检查中证实已无明显粪便积聚,之後持续以电针治疗六次,逐渐改善肠胃症状,增进 食欲和进食量。因此我们认为电针可有效改善肠造口关闭後的术後肠阻塞,恢复肠胃道蠕动,帮助病患提早出院。
【关键词】电针、术後肠阻塞、肠造口关闭
Hsuan-Ting Tang1 Ming-Cheng Huang1,*
 1 Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
【Summary】
Postoperative ileus is the most common and crucial complication following loop ileostomy closure, which leads to important health care issue that may delay discharge from the hospital after surgery. The cardinal symptoms of postoperative ileus include nausea and vomiting, inability to tolerate oral intake, abdominal distension, and delayed passage of flatus or stools. At present, supportive care including pain management, diet restriction, bowel decompression with a nasogastric tube placed, peripheral nutritional support is the mainstay of treatment for those with postoperative ileus. However, the gastrointestinal recovery time is unpredictable. This 69-year-old male patient diagnosed as rectal cancer six months ago owing to recurrent rectal bleeding. After surgical intervention of robotic low anterior resection and concurrent chemoradiotherapy, he was admitted to the China Medical University Hospital for ileostomy closure surgery on July 6, 2021. Because of postoperative complications such as constipation and abdominal distension, the patient asked for acupuncture treatment as adjuvant therapy. Only a few feces the patient defecated after three sessions of acupuncture treatments. He had a nasogastric tube placed for bowel decompression resulted from consistent abdominal distension and vomit episodes. Given to the dose of acupuncture might be insufficient, we shifted the manual acupuncture to electroacupuncture. Then, his abdominal distension was greatly relieved, and the defecation gradually increased. The colonoscopy showed no obvious fecal impaction which confirmed the effect of electroacupuncture therapy. After six sessions of the electroacupuncture treatments, the patient with improved appetite was discharged smoothly. As a result, we believe that electroacupuncture can effectively ameliorate the symptoms of postoperative ileus after ileostomy closure surgery, restore gastrointestinal motility, and help patients to be discharged early.
Keywords
Electroacupuncture; postoperative ileus; ileostomy closure