探讨经鼻型肠梗阻导管小肠减压与高选择性小肠造影在肠梗阻诊断及治疗中的应用价值。

选取我院2012年2月—2014年10月收治的36例小肠梗阻患者，均在胃镜辅助下先行经鼻型肠梗阻导管置入减压，减压后通过肠梗阻导管进行高选择性小肠造影，动态多角度观察肠管的形态、运动及梗阻局部情况，对小肠梗阻的部位、范围、性质做出影像学诊断，并结合手术及病理结果和治疗效果进行分析。

36例患者全部置管、造影成功。14例经非手术治疗治愈，22例经手术治疗治愈。本组病例术前影像诊断与临床最终诊断符合率为94.4%（34/36）。术前15例影像诊断粘连性肠梗阻，经非手术治疗痊愈13例，2例非手术治疗无效中转手术，非手术治疗梗阻解除率为86.6%（13/15）。8例影像诊断肿瘤性肠梗阻均行手术治疗，7例符合诊断，1例误诊为肠结核。5例影像诊断小肠内疝性肠梗阻均行手术治疗，4例符合诊断，1例误诊为肠粘连。4例影像诊断小肠结石性肠梗阻，其中3例手术治疗，1例经非手术治疗痊愈。4例影像诊断肠套叠性肠梗阻行手术治疗均符合诊断。

经鼻型肠梗阻导管小肠减压能够迅速减轻肠梗阻症状，减少急诊手术，部分患者可经非手术治疗治愈。需要中转手术者，也可对其梗阻部位、程度及梗阻病因等进行初步判明，使手术更具针对性。经鼻型肠梗阻导管造影对小肠梗阻的定性定位诊断有较高的临床应用价值。

To explore the application value of intestinal decompression through transnasal tube and highly selective enterography in the diagnosis and treatment of small intestinal obstruction.

Thirty-six patients with small intestinal obstruction from February 2012 to October 2014 were selected. Intestinal decompression using transnasal tube assisted by endoscopy was applied in all patients and then highly selective enterography through transnasal tube was carried out. The morphology, movement and obstruction of focal bowel were observed dynamically and imaging diagnosis was made, combined with intraoperative findings, pathological diagnosis and treatment effect.

Transnasal tube placement and enterography were performed successfully in all patients. Among 36 patients, 14 patients were cured conservatively and 22 patients were cured using surgical treatment. The diagnosis agreement between preoperative imaging diagnosis and postoperative diagnosis was 94.4% (34/36) . In 15 patients with adhesive ileus, 13 patients were cured conservatively (86.6%, 13/15) and surgery was performed in two patients because of ineffective nonoperative treatment. In 8 patients with tumorous ileus, 7 patients were proved in operation and intestinal tuberculosis was found in the other patient. In 5 patients with internal hernia obstruction, 4 patients were proved in operation and intestinal adhesion was found in the other patient. In 4 patients with intestinal stone, 3 patients were cured conservatively and one patient was cured by operation. Intussusception in 4 patients was proved by operation.

Intestinal decompression using transnasal tube can quickly relieve abdominal pain in patients with intestinal obstruction and avoid emergency operation. Some patients with benign obstruction can be cured by conservative treatment. In order to make the operation more targeted, it is necessary to determine the cause of obstruction, degree and obstruction for transfer operation. Transnasal tube enterography is of great value to quantitative and locative diagnosis in patients with intestinal obstruction.