术后早期肠梗阻9例临床分析

Clinical analysis of 9 cases with early postoperative small bowel obstruction

目的探讨术后早期肠梗阻的概念、发生率、发生原因、诊断及治疗原则。方法回顾性分析诊治的9例术后早期肠梗阻患者的临床资料,并结合相关文献进行分析总结。结果本研究中术后早期肠梗阻的发生率为1.1%,出现术后肠梗阻症状的时间为术后4～40 d;主要临床表现均为腹胀、腹痛、呕吐;影像学腹部X线平片有液气平面等相应梗阻征象;8例考虑与术后粘连和炎症因素有关,另外1例术中证实为空回肠交界处与第一次手术切口粘连成角引起的机械性肠梗阻。8例经胃肠减压、应用抗生素、外周补液等保守治疗治愈,1例经手术治疗缓解。结论术后早期肠梗阻是指术后50 d之内出现梗阻症状和体征,并有影像学的参考证据,或经手术证实。粘连和炎症为发病主要因素,临床表现缺乏特异性,诊断需要影像学的参考依据及外科医师的临床经验。治疗取决于引起梗阻的原因及临床病情进展情况。

Objective To study the definition, incidence, etiology, diagnosis, and treatment of early postoperative small bowel ob- struction. Methods Based upon the comprehensive literature review, a retrospective analysis of 9 clinical cases with early postoperative small bowel obstruction was conducted in our Department from 2008 to 2011. Results The prevalence of early postoperative small bowel ob- struction was 1.1% in the current study, with the time of appeared symptoms of postoperative ileus ranged from 4 to 40 days after surgery. This finding was consistent with the existing literature which suggested postoperative ileus occurred within 50 days after surgery. The main clinical manifestations were abdominal distension, abdominal pain, and vomiting. The images of radiologic plain abdominal x - ray films indi- cated the presence of distended small bowel loops with air - fluid levels. Eight cases were likely to be caused by adhesive and in？ ammatory factors, while another one case was mechanical intestinal obstruction with subsequent con？ rmation at re -laparotomy. All nine cases were initially treated nonoperatively with intestinal intubation, antibiotics and parenteral fluids, with eight cases cured and one case relieved after surgery. Conclusion Early postoperative small bowel obstruction refers to the occurrence of symptoms and signs of obstruction within 50 days after the surgery, usually having the evidence of radiographic imaging, or confirmed by operation. Adhesion and inflammation are the major factors regarding the pathophysiology. Because of lacking of specific clinical manifestations, diagnosis more likely depends on radiological in- vestigations and the surgeong clinical experience. Treatment should be carefully based on the causes and clinical progress.