腹部手术后早期炎性肠梗阻的治疗

Treatment of early postoperative inflammatory small bowel obstruction

目的 探讨术后早期炎性肠梗阻的特点及治疗原则。方法 回顾性分析近期经治的术后早期炎性肠梗阻 9例。结果 1例患者经手术治疗，分离粘连时引起多发性肠破裂、肠瘘，后经保守治疗治愈； 8例患者均经胃肠减压、抗炎、应用生长抑素等保守治疗治愈，平均治愈时间为 21. 5 d，无 1例肠坏死。结论 术后早期炎性肠梗阻的特点： (1)发生于腹部手术后早期，虽有机械性因素，但大多都是腹腔内炎症所致广泛粘连引起； (2)症状以腹胀为主，腹痛相对轻，部分患者有少量肛门排气排便，体征虽典型，但较少发生绞窄； (3)保守治疗大都有效，治疗上最好先予以生长抑素为主的保守治疗，应严密观察，如出现肠坏死、腹膜炎征象时则再及时中转手术。

Objective To investigate the clinical characteristics and treatmnet principles of early postoperative inflammatory small bowel obstruction.Methods Clinical data of 9 cases of early postoperative inflammatory small bowel obstruction was analyzed retrospectively.Results One patient underwent operation,during which multiple rupture of small intestine happened,and resulted in postoperative fistula.This patient recovered after conservative treatment.Other 8 patients recovered after non- operative treatment including gastrointestinal decompression,administration of antibiotics and somatostatin,etc.The mean cure time was 21.5 days and none had intestinal necrosis.Conclusions The characterstics of early postoperative inflammatory small bowel obstruction:(1)It always occurs during the early stage after abdominal operation,mainly because of intestinal adhesions resulted from abdominal inflammation.(2)The main symptoms include abdominal distention and mild abdominal pain.Passage of flatus or stool happens in some patients.Although the signs are typical,strangulation seldom occurs.(3)Conservative treatments including somatostatin are effective.Surgical intervention is imperative once intestinal necrosis or peritonitis happen.