肠梗阻599例临床研究及文献回顾-599 cases of intestinal obstruction clinical research and literature review.docxVIP

肠梗阻500例临床分析摘肠梗阻500例临床分析摘 要目的：总结我院10年来肠梗阻的诊治经验。防i法：对我院1990年～2000年间收治的肠梗阻病人的病因、诊断及治疗进行回顾性分析，结合有关文献讨论肠梗阻的诊治问题。结果：10年内我院共收治599例肠梗阻。病因明确540例(90．2％)， 其中机械性肠梗阻529例(98．0％)、麻痹性肠梗阻lO例(1．9％)、血运 性肠梗阻1例(0．1％)；原因不明59例(9．8％)。位居机械性肠梗阻前五 位的是粘连性386例(73．0％)，肿瘤性81例(15．3％)，嵌顿疝19例(3．6％)， 肠扭转14例(2．6％)，粪石嵌塞10例(1．9％)。术中诊断绞窄性肠梗阻51 例(9．7％)，其中23例(45．1％)术前做出诊断，其余28例(54．9％)分 别以单纯性肠梗阻或其它急腹症行剖腹探查而确诊。{E至苤迨疗38l例(63．6％)，死亡16例，其中9例多器官功能衰竭，2例严重水电解质、酸碱紊乱，2例脓毒性休克，2例肾功能衰竭，1例心跳骤停；手术治疗218 例(36．4％)，术后发生并发症7例，其中切口感染、裂开各3例，肠瘘 1例；死亡11例，其中5例多器官功能衰竭，6例脓毒性休克。夫结论：10年间肠梗阻以粘连性肠梗阻、肿瘤性肠梗阻最常见；粘连性 肠梗阻中84．2％为手术后所致，其中阑尾切除术、妇科手术及直肠切除是 最为常见手术类型；青年、无手术史的肠梗阻主要为结核性粘连所致。肿 瘤性肠梗阻临床表现有别于粘连性肠梗阻。绞窄性肠梗阻51例，腹部体 征是最主要的鉴别手段，严密观察可以及时发现。本组381例(63．6％) 行非手术治疗，365例缓解。主张对手术后早期粘连性肠梗阻应以非手术 治疗为主。本组死亡27例(4．5％)：未手术者16例死亡，手术后死亡1l 例。关键词：肠梗阻病因。胗断治瘃，V 、TVClinical Clinical analysis of the diagnoses and treatment ofintestinal Obstruction：A review of 599 casesAbstractObjective：To summarize our experience in the diagnoses and treatment of intestinal obstruction．Methods：The etiological factors．diagnoses and treatment of patients、衍m intestinal obstruction from January 1990 to December 2000 were analyzed retrospectively with a review of recent domestic and foreign literatures at the same time．Results：A total of 599 patients with intestinal obstruction were recorded during mentioned above 10 years．Definitive causes were made in 540 cases (90．2％)，but 59 cases(9．8％)not．Mechanical bowel obstruction occurred in 529 patients(98．O％)’paralytic ileus in 10(1．9％)，and mesenteric vascular embolism due to obstruction in 1(0．1％)．Among the causes of mechanical bowel obstruction，386 cases(73．O％)were due to peritoneal adhesion，81 Cases (15．3％)intestinal malignant Rlmors，19 cases(3．6％)incarcerated hernia，14 cases(2．6％)volvulus and 1 0 cases(1．9％)fical impaction．Intestinal strangulation obstruction was defined in 51 cases(9．7％)during operation，23cases(45+l蛳in preoperative diagnosis，and the rest patients with laparotomyin diagnozing simple obstruction or other acute abdomen．381