术后早期炎性肠梗阻的诊治分析

The diagnosis and treatment of Hospital early postoperative inflammatory small bowel obstruction

目的探讨腹部手术后早期炎性肠梗阻的病因、临床特点和诊治原则。方法回顾性分析我院近期诊治的术后早期炎性肠梗阻19例。结果17例患者经胃肠减压、抗炎、应用生长抑素、全胃肠外营养结合中药等保守治疗治愈;2例患者经手术治疗,无效后经保守治疗治愈。平均治愈时间为12d,无1例肠坏死。结论术后早期炎性肠梗阻好发于腹部手术后2周以内,主要是因为腹腔内炎症所致广泛黏连所引起;症状以腹胀为主,腹痛相对较轻,部分患者有少量肛门排气排便,体征虽典型,但很少发生肠绞窄坏死。治疗上最好先予以生长抑素为主的保守治疗,治疗过程中应严密观察,如出现肠坏死、腹膜炎征象时应及时中转手术。

Objective To investigate the cause,clinical characteristics,diagnosis and treatment principles of early postoperative inflammatory small bowel obstruction（EPISBO）. Methods Clinical data of 19 cases of early postoperative inflammatory small bowel obstruction were analyzed retrospectively. Results 17 patients recovered after non-op- erative treatment including gastrointestinal decompression,administration of antibiotics and somatostatin, total parenter somatostatin and traditional Chinese medicine,etc. The other two patients underwent operation and recovered after conservative treatment. The mean cure time was 12 days and none had intestinal necrosis. Conclusion The early postoperative inflammatory small bowel obstruction always occurs within two weeks after abdominal operation ,mainly because of intestinal adhesions resulted from abdominal inflammation. The main symptoms include abdominal distention and mild abdominal pain. Passage of flatus or stool happens in some patients. Although the signs are typical, strangulation seldom occurs. Conservative treatments including somatostatin are effective. Surgical intervention is imperative once intestinal necrosis or peritonitis happens.