急性粘连性小肠梗阻外科干预时机适应证与预后分析.docVIP

急性粘连性小肠梗阻外科干预时机适应证与预后分析 　　【摘要】 目的 探讨急性粘连性小肠梗阻外科干预的时机、适应证与预后分析。方法 回顾性总结分析2000年1月至2009年7月收治的48例急性粘连性小肠梗阻的临床资料、手术时机和适应证。结果 治愈41例,好转5例,死于感染性休克2例,术后并发肺部感染10例,切口感染8例,腹腔残余脓肿5例,短肠综合征3例,肾功能不全2例,经综合治疗后痊愈。结论 急性粘连性肠梗阻在保守治疗过程中应及时发现早期肠绞窄的线索,果断决定手术治疗,手术时机宜早勿迟,手术指征宜宽勿严是提高临床治愈率、降低并发症和病死率的重要措施。 　　【关键词】 急性粘连性小肠梗阻;手术时机;手术适应证 　　 　　The acute adhesive small-bowel obstruction timing of surgical intervention、 indications and prognosis 　　LU Zhi-kun,ZHANG Quan-feng.Department of General Surgery,The Gaozhou Hospitai of TCM,Maoming,Guangdong,525200,China 　　【Abstract】 Objective To investigate the acute adhesive small-bowel obstruction timing of surgical intervention、indications and prognosis. Methods A retrospective analysis of 48 cases of acute adhesive small-bowel obstruction of the clinical data,surgical timing and indications,which were treated from January 2000 to July 2009. Results 41 patients cured,5 cases improved,two deaths from septic shock,postoperative pulmonary infection in 10 cases,8 cases of wound infection,intra-abdominal residual abscess in 5 cases,short bowel syndrome in 3 cases,2 cases of renal insufficiency,which were cured through combined treatment. Conclusion Acute adhesive intestinal obstruction in a conservative course of treatment should be to discover clues of early intestinal strangulation,decisive decision to surgical treatment,timing of surgery are advised to be early,not late.Being loose instead of strict in surgical indications is the important measures to improve the clinical cure rate and reduce complications and mortality. 　　【Key words】 Acuteadhesive small intestinalobstruction;Surgical timing ;Surgical indication 　　 　　机械性小肠梗阻是腹部外科常见疾病之一,主要是由手术后并发症引起,如粘连、内疝、瘢痕狭窄,也可由肠扭转、肿瘤、肠腔内结石、蛔虫等引起,但粘连性肠梗阻已成为小肠梗阻的主要原因。因此急性粘连性小肠梗阻是临床上常见的急腹症,而延???诊断、错失手术时机则是增加患者的痛苦、出现严重的并发症而失去抢救的时机,酿成无法挽救的后果。以致对于肠梗阻严重程度的判断及外科干预的时机的选择,对肠梗阻患者的预后有着重要意义。现将本院2000年1月至2009年7月手术治疗急性粘连性小肠梗阻患者48例,占同期收治粘连性肠梗阻患者的40%(48/120)进行回顾性总结,分析讨论急性粘连性小肠梗阻的治疗方法与预后关系。 　　1 资料与方法 　　1.1 临床资料 男33例、女15例,年龄10～81岁