腹部手术后早期炎性肠梗阻的诊断与治疗

Diagnosis and Treatment of the Early Postoperative Inflammatory Small Bowel Obstruction Aafter Abdominal Operation

目的探讨腹部手术后早期炎性肠梗阻的临床特点与治疗。方法回顾性分析2000-01/2008-0 1本院保守治疗腹部外科手术后早期炎性肠梗阻患者31例的临床资料。结果本组患者经腹部肿瘤根治手术17例（55%）,化脓性和坏疽性阑尾炎术后5例（16.13%）,小肠外伤穿孔部分切除术后3例（9.68%）,广泛肠粘连分离6例（19.35%）。肠梗阻主要发生在术后5-8 d,27例发生在2周内。发生炎性肠梗阻后保守治疗1周内患者肠梗阻症状及体征均开始缓解,经过2周左右的保守治疗28例胃肠道功能恢复。有3例超过3周,平均治愈时间为15.1 d。结论腹部外科手术后早期炎性肠梗阻是较常见的并发症,临床表现特殊,治疗期间严密观察病情变化,采用保守治疗是可行的。

Objective To investigate the clinical feature and the treatment of the early postoperative inflammatory small bowel obstruction（EPISBO）.Methods The clinical date of 31 patients with EPISBO afterabdominal operation who were treaded during January 2000 to January 2008 were analyzed retrospectively.Results There were 17 cases occurred EPISBO after abdominal operation with malignant tumor（55%）,57 cases occurred after operarion on suppurative or gangrenous appendicitis（16.13%）,3 cases occurred after partial resection of traumatic perforation of small intestine（9.68%）,67 cases occurred after operation on intestinal adhesion（19.35%）.The bowel obstruction mainly occurred in 5-8 day postoperation mainly.27 cases occurred after abdominal operation in two weeks.The pathological sign and symptom of bowel obstruction started to relieve underwent conservative treatment after EPISBO.There were 28 cases of gastrointestinal function recovered in 2 weeks after conservative treatment and 3 cases′ recovery time were over 3 weeks.The average healing time was 15.1 days.Conclusion The EPISBO is a common complication after abdominal operation with specific clinical manifestations.The abdominal CT has important value in the diagnosis of EPISBO.It is necessary to observe the changes in patients′ condition during the treatment period closely.The conservative treatment is feasible.