急性粘连性肠梗阻病人手术适应证及手术时机的探讨

The study of the surgical indications and time for surgery for the acute adhesive intestinal obstruction

目的:探讨急性粘连性肠梗阻病人的手术时机,以提高手术治疗效果。方法:回顾性分析我院1998～2008年手术治疗的61粘连性肠梗阻病例的临床资料,其中7例行腹腔镜粘连松解术。术中使用2～3支医用几丁糖凝胶以防止肠粘连。结果:本组手术治疗61例,非手术治疗95例。手术治疗患者中痊愈55例(88.2%),二次手术5例(10%),三次手术1例(2%)。术后肺部感染2例,切口感染3例,肠瘘2例,经保守治疗痊愈。1例死于感染性休克合并多器官功能衰竭综合征。结论:在非手术治疗前提下,粘连性肠梗阻病人手术时机宜把握在24～48 h。对粘连性肠梗阻病人应采取因人而异的个体化原则,重在密切观察病情的演变和有效的非手术治疗。术中应用医用几丁糖凝胶可以减少肠粘连,防止复发。

Objective： To study the opportunity of the acute adhesive intestinal obstruction surgery patients and improve the effectiveness of surgical treatment. Methods： A retrospective analysis of 61 cases of adhesive intestinal obstruction of surgical treatment over the past 10 years in our hospital, some patients were given laparoscopic surgery lysis. 2-3 branches Medical chitosan used in the all operations. Results： 61 cases receive surgery, 95 cases treat with non-surgical; surgery patients recovered in 55 accounts for 88.2 percent. 5 cases receive second operation, accounting for about 10% ; 1 case receive three times by 2% ; after operations, 2 cases with pulmonary infection, 3 cases with wound infection, 2 cases with intestinal fistul cured by conservative treatment; 1 case died of septic shock merger Multiple organ dysfunction syn- drome. Conclusion： Of non-surgical treatment in. adhesive intestinal obstruction 24 to 48 hours the time is appropriate, up to 72 hours. The patient of adhesive intestinal obstruction should been taken the principle of individual, focus on close observation of the evolution of the disease and effective non-surgical treatment. Medical chitosan can reduce adhesion and prevent recurrence.