粘连绞窄性肠梗阻28例诊治分析

Analysis of diagnosis and treatment of adhesive strangulated intestinal obstruction:Report of 28 cases

目的探讨粘连绞窄性肠梗阻的早期诊断及有效的手术治疗方法。方法回顾分析经手术治疗28例粘连绞窄性肠梗阻的临床资料。结果 28例患者均诊断为粘连绞窄性肠梗阻而行手术探查,术中发现肠坏死行肠切除13例(46.4%),其余15例(53.6%)单纯粘连松解、粘连松解+扭转复位、部分小肠外排列术。本组患者均治愈。结论 CT、B超对粘连绞窄性肠梗阻的早期诊断有重要临床意义。及时的手术治疗、术后对感染中毒性休克、多脏器功能衰竭及严重水电解质紊乱及酸碱失衡治疗的重视、营养的支持是降低死亡率的关键。

Objective To discuss the early diagnosis and the effective surgical methods for the adhesive strangulated in- testinal obstruction. Methods Retrospective analysis on the clinical data of 28 patients with the adhesive strangulated intestinal obstruction who underwent surgery. Results All patients were diagnosed as the adhesive strangulated intesti- nal obstruction before the abdominal surgery. During the operation, 13 patients （46.4%） underwent the intestinal re- section due to intestinal necrosis. The other 15 patients underwent adhesiolysis, adhesiolysis ＋ replacement or partial intestine arrangement. All patients were cured. Conclusion It is clinical significant for the early diagnosis of adhesive strangulated intestinal obstruction by applying CT and/or B ultrasonic. The main factors of decreasing mortality are timely operation, paying more attention to the toxic shock, multiple organ failure and serious disturbances of water, electrolyte as well as acid-base balance after the operation. Nutrition support is also very important.