3)イレウス管挿入 (1)経鼻

Technique for Insertion of a Long Intestinal Tube

要旨　腸閉塞におけるイレウス管による減圧は有効な治療であり，広く行われている．挿入に際し，まず十分説明し患者の同意を得る．透視台に患者を仰臥位にし，イレウス管先端が胃内に挿入されたら，用手圧迫や体位変換などを行い，幽門輪に誘導し，通過させる．イレウス管を十二指腸下行脚からTreitz靭帯を越えた上部空腸に進める．幽門輪通過が困難な場合は内視鏡を併用する．バルーンを膨らませ，ガストログラフィンにて造影し，イレウス管の位置を確認する．可能ならば閉塞部位を検索する．イレウス管操作は患者の状態を考え，慎重かつ愛護的に行う．

　Bowel decompression using a long intestinal tube is widely recognized as an effective treatment of ileus. Prior to this treatment, written informed consent should be obtained for all patients. First, a patient is placed on a fluoroscopic table in the supine position. Next, the tube is inserted transnasally into the stomach. Intubation into the pyloric ring is manually performed although changing the patient's body position is also required in many cases. Afterwards, the tube is advanced to the upper jejunum beyond the ligament of Treitz from the descending part of the duodenum. The use of an endoscope should be considered in technically difficult cases to facilitate the insertion of the tube into the pyloric ring. Finally, a balloon at the tip of the tube is inflated and the position of the tube is fluoroscopically confirmed. It is desirable to examine the obstructed part simultaneously with contrast injection via the tube. All of those procedures should be cautiously performed to reduce risk of peri-procedural complications.