三阶段微创治疗急性粘连性肠梗阻

Three stages minimally invasive treatment in acute adhesive intestinal obstruction

目的:建立分阶段中西医结合与腹腔镜微创手术联合治疗急性粘连性肠梗阻的方案,并探讨此方案的治疗效果。方法:将1997年10月至2004年12月急性粘连性肠梗阻173例患者分为三个阶段进行中西医结合微创联合治疗。第1阶段:急性期中西医结合非手术治疗解除梗阻,未解除梗阻者行急症腹腔镜探查或剖腹手术。第2阶段:缓解期行腹腔镜肠粘连松解术,去除引起肠梗阻的病因。第3阶段:是疗效巩固期,用中药治疗以避免术后粘连性肠梗阻再发。结果:术后随访,三阶段联合治疗71例,复发4例(5.6%);单纯中西医结合非手术治疗39例,复发24例(61.5%);开腹行肠粘连松解术15例,复发5例(33.3%)。急症腹腔镜手术15例,中转开腹7例(46.7%),发生并发症6例(40%);择期腹腔镜手术77例,中转开腹6例(7.8%),发生并发症6例(7.8%)。结论:分阶段中西医结合微创联合治疗急性粘连性肠梗阻的效果明显优于单一治疗方式。

Objective： To establish a scheme, in which the combination of traditional chinese medicine （TCM） and western medicine as well as laparoscopic surgery can be carried out by stages in treatment of acute adhesive intestinal obstruction. And to explore the effect of this new method. Methods：From October of 1997 to December of 2004,173 patients suftered from acute adhesive intestinal obstruction were treated by three stages. In the first stage, known as acute phase, the eases were initially managed with combination of TCM and western medicine to resolve the obstruction. If the obstruction could not be released,the conversion to emergency laparoscupic operation or laparotomy was necessary. In the second stage,known as remission phase, selective laparoscopic adhesiolysis was attempted to resolve the obstruction. And in the third stage, Herb medicine was adopted in the curative effect＇consolidation phase to prevent the recurrence of adhesive small bowel obstruetion. Results：By following-up,71 cases were treated in three stages, among them 4 cases（ 5.6% ） recurred adhesive small bowel obstruction ;39 cases were only conservative treated with combination of TCM and western＇ medicine,24 cases （61.5 % ） recurred ; 15 cases were selected to undergo laparotomy, 5 cases （ 33.3 % ） recurred. Emergency laparosoepic operation was performed in 15 cases,while conversion to laparotomy proved to be necessary in 7 eases （46.7%） ,6 cases （40%） had some complications. 77 cases underwent selective operation adhesiolysis,6 cases（7.8% ） converted to laparotomy,6 cases（7.8% ） had some complications. Conclusions：The scheme in which the combination of TCM and western medicine as well as laparoscopic surgery can be carried out by stages,and has an advantage over single treatment.