小肠排列术治疗复杂性肠梗阻的临床研究

Clinical research of intestinal plication in treating complicated intestinal obstruction

目的:观察小肠排列术治疗复杂性肠梗阻的临床效果。方法:将95例复杂性肠梗阻病例随机分为常规手术组、单排列组和双排列组。观察术后各组病例首次排气、排便、腹胀消除时间及并发症发生情况,术前、术后早期(1～2 d)、中期(3～5 d)、后期(7 d以后)C-反应蛋白变化。术后随访12～36个月,观察肠梗阻复发情况。结果:三组术后排气、排便及腹胀消除时间比较,差异无统计学意义(P>0.05)。各组间术前及术后各时间段CRP比较,差异无统计学意义(P>0.05)。各组间术后并发症发生率比较,差异无统计学意义(P>0.05)。常规手术组术后复发率为20.7%,单排列组复发率为6.5%,双排列组无复发,单排列组及双排列组复发率明显低于常规手术组,差异有统计学意义(P<0.05)。结论:采用小肠内置管加外固定双排列术治疗复杂性肠梗阻,疗效满意,可明显降低术后复发率,是一种简单、易行、安全、可靠、有效的术式,具有较好的临床应用和推广价值。

Objective To observe the clinical effect of intestinal plication in treating complicated intestinal obstruction.Method Total 95 complicated intestinal obstruction patients were randomly divided into general operation group,single intestinal plication group and double intestinal plication group.The first time of aerofluxus and defecation,the time of abdominal distention releaving and complications were observed respectively in every group after operation.WBC and CRP were monitored before operation and in early period（1~2 d）,middle period（3~5 d） and later period（7 d later）,postoperatively.All the patients were followed up ranging from 12~36 months and observed the recurrence of bowel obstruction.Results The first time of aerofluxus and defecation,the time of abdominal distention releaving and the rate of complications were not found significant difference postoperatively between the three groups（P〈0.05）.The WBC and CRP level had no marked difference between the three groups at any time（P〈0.05）.The rate of recurrence in general operation group was 24.1%;the rate of recurrence in single intestinal plication group was 6.5%;no recurrence was found in double intestinal plication group.The rate of recurrence of intestinal plication group was significantly lower than general operation group（P〈0.05）.Conclusion The effect of intestinal intubation plication ＋ suture plication in treating complicated intestinal obstruction is satisfied.This operation mode can apparently decrease the rate of postoperative recurrence.It is a simple,secure and effective operation mode.It has the good value of clinical using and spreading.