术后早期炎性肠梗阻112例诊治分析.docVIP

术后早期炎性肠梗阻112例的诊治分析 　　作者：商义1,张才全2　　作者单位：四川南充，川北医学院校医院　2 400016 重庆，重庆医科大学附一院(通讯作者) 　　【摘要】目的研究术后早期炎性肠梗阻的诊断以及治疗措施。方法回顾性分析本院1999年1月mdash;2009年12月收治的112例术后早期炎性肠梗阻患者的病例资料。结果99例患者经保守治疗治愈，平均治愈时间10天。13例中转手术治疗后治愈，其中8例保守治疗时出现绞窄性肠梗阻而中转手术，5例保守治疗5周无效而中转手术。结论术后早期炎性肠梗阻应仍以保守治疗为主。小剂量低分子肝素、胃肠外营养及生长抑素的联合应用具有较佳的疗效。 　　【关键词】 炎性肠梗阻;保守治疗;小剂量低分子肝素 　　[Abstract] Objective To investigate the experiences on the diagnosis and treatment of early postoperative inflammatory in small bowel obstruction.Methods The clinical data of 112 cases of early postoperative inflammatory in small bowel obstruction treated in our hospital from January, 1999 to December, 2009 were analyzed retrospectively.Results Of the 112 cases，99 cases were cured by routine conservative method, and the mean time from the onset of symptoms to the recovery of bowel function was 10d. 13 cases were cured by transferring to operation. Of them, 8 cases were transferred to operation because of strangulated intestinal obstruction during the period of conservative treatment, 5 cases underwent operation because they didnt recover after 5 weeks expectant treatment.Conclusion The early postoperative inflammatory in small bowel obstruction should be subjected to conservative treatment. Small dosage of low molecular weight heparin, parenteral nutritional support and somatostatin therapy have the therapeutical effects to some extent. 　　[Key words] inflammatory in small bowel obstruction;conservative treatment ;low molecular weight heparin 　　术后早期炎性肠梗阻(early postoperative inflammatory small bowel obstruction，EPISBO)为腹部外科手术常见并发症之一，由于外伤、手术创伤或腹腔内炎症等导致肠壁水肿和渗出而形成的一种机械性与动力性同时存在的粘连性肠梗阻。一般发生在腹部手术后1～3周，如处理不当会引起肠瘘、感染等严重并发症。本院自1999年1月mdash;2009年12月共收治术后早期炎性肠梗阻112例，经治疗后取得满意的疗效。现报告如下。 　　1 资料与方法 　　1.1 一般资料 本组112例，其中男66例，女46例;年龄11～85岁，中位年龄48岁。所有病例在术后胃肠功能恢复正常后出现肠梗阻的临床表现，症状出现时间为术后6～27(平均8.2)天。导致术后早期炎性肠梗阻的手术为急性化脓性阑尾炎行阑尾切除术32例，胆囊切除术6例，胆肠吻合术9例，胃十二指肠溃疡穿孔修补术16例，小肠部分切除术8例，脾破裂修补术7例，肝破裂修补术5例，粘连性肠梗阻粘连松解术14例，结直肠癌根治术10例，胃癌根治术5例。既往有手术史的33例，其中2次手术以