术后早期肠梗阻及其治疗策略

Early postoperative intestinal obstruction and its management

目的 探讨术后早期肠梗阻的治疗方法。方法 对 10例术后早期肠梗阻的临床特点和治疗方法进行回顾性分析。结果 10例术后早期肠梗阻 (9例确诊为粘连性 )均发生于术后 1周内 ,保守治疗 7例 ,肠梗阻缓解时间 3～3 0d,平均 10 3d;手术治疗 3例 ,1例梗阻后 4 8h手术 ,术中见回盲部广泛粘连 ,肠壁重度炎症改变 ,行回 结肠部分切除术后再发肠梗阻 ,保守治疗 18d痊愈 ;另 2例分别于梗阻后 5周及 6周手术 ,腹腔内未见广泛粘连及肠壁炎症改变 ,术后恢复顺利。结论 对术后早期粘连性肠梗阻应先行 4～6周保守治疗 ,逾期无缓解者再行手术 ,这样可避免不必要的手术并减少术后并发症。

Objective To explore the appropriate strategy for the treatment of early postoperative intestinal obstruction.Methods 10 cases of early postoperative intestinal obstruction were retrospectively analysed mainly on clinical characteristics and treatments.Results Intestinal obstruction occurred within the first week after operation in all the 10 cases(9 were diagnosed as adhesive obstruction).7 cases achieved remission in 3～30 days(mean 10.3 days) by conservative treatment.1 case underwent operation in 48 hours after the occurrence of intestinal obstruction.Extensive adhesion and severe inflammation of the ileocecal bowel wall was observed during laparotomy.Partial ileocolectomy was performed and early postoperative intestinal obstruction occurred on second session followed by conservative therapy for 18 days before total recovery.The other 2 cases underwent laparotomy on the 5 th and 6 th week after obstruction,respectively and found no extensive intraperitoneal adhesion or inflammation.These two patients recovered uneventfully after exploration.Conclusion 4～6 weeks conservative treatment is necessary for all patients with early postoperative intestinal adhesive obstruction before obstruction relieving operation is considered.This protocol can prevent unnecessary operation and reduce postoperative complications.