高齢者の術後癒着性イレウスにおけるイレウス管留置の功罪

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  • CONSERVATIVE TREATMENT FOR ADHESIVE ILEUS IN THE AGED: ADVANTAGES AND DISADVANTAGES OF LONG TUBE PLACEMENT

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In treating postoperative adhesive ileus in the aged patients, we tried to clarify the advantages and disadvantages of long tube placement. Of a series of 234 patients with adhesive ileus admitted to the hospital from April 1998 to September 2002, 147 patients received conservative treatment with long tube placement. Ninety-seven out of the 147 patients who received gastrografin follow-through study were classified into two groups according to the age: over 75 years (n=15; aged group) and under 75 (n=82; younger group). The two groups were compared for the baseline chracteristics, characteristics of long tube management, operation rate, complications during long tube placement, and death rate. The drainage volume through a long tube decreased more clearly in the younger group, whereas in the aged group, the abdominal condition did not improve and the drainage volume of gastrointestinal juice was unchanging at a rate of more than 400ml/day. Significant differences were noted in the location of the tip of long tube and duration of long tube placement (76 vs. 45 hours) between the aged and younger groups. A significantly more patients (25%) in the aged group developed complications during the conservative treatment (P<0.01).<br> In implementing conservative treatment for the aged patients, we should manage the long tube carefully to avoid complications such as pneumonia. This study provides a solid basis for the effective management of long tube placement in challenging cases of postoperative adhesive ileus in the aged patients.

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