急性结肠梗阻57例的诊断与治疗

Diagnosis and management of acute large bowel obstruction

目的 探讨急性结肠梗阻的诊断、围手术期处理及手术方式的选择。方法 回顾分析我院1991年1月- 1997年11月间手术治疗的急性结肠梗阻5 7例。结果 癌性结肠梗阻占71.9% (41/ 5 7) ,而术前确诊率仅31.7% (13/ 4 1)。术前选用预防性抗生素静滴,术中行肠减压、结肠灌洗,Ⅰ期切除手术4 4例,占77.2 % (44 / 5 7) ,无死亡及吻合口漏发生。结论 对急性结肠梗阻应加强术前诊断,减少Ⅰ期肠切除吻合术后并发症是降低失败率的关键。

Objective:The purpose of this study was to evaluate the diagnosis,Preoperative management,and procedure's choice of acute large bowel obsturction(ALBO).Methods:57 cases of ALBO operated upon between Jan.1991 and Nov.1997 were reported and related problems were discussed.Results:There were 41 cases(71.9 %,41/57)of acute carcinomatous colonic obstruction (ACCO)among them,But the pre-operative diagnosis rate of ACCO was only 31.7 %(13/41).Through protective antibiotic intervention and on-table proximal decompression or/and larvae,44 patient (77.2 %)underwent single-stage resection,of whom 36 patients (81.8 %)underwent primary anatomists.including 20 cases of left colonic elision.In this group there were on deaths and leaks.Conclusion;We believed that it was the key to enhance pre-operative diagnosis or recognize and preoperative management of ALBO for decreasing mortality and morbidity of single-stage resection and anatomists.