原因不明的慢性不全性肠梗阻21例手术治疗体会

Surgical treatment of undetermined origin of chronic incomplete intestinal obstruction :experience of 21 cases

目的总结未明原因的慢性不全性肠梗阻患者的手术治疗经验。方法选取2000年5月至2014年5月间,我院收治的21例原因不明的、未曾接受手术的非器质性病变所致慢性不全性肠梗阻病人的临床资料,所有患者均接受部分结肠切除术或结肠脾曲松解术。患者的临床表现、诊断及手术适应症进行回顾性分析。结果所有患者均以长期的、有不同程度的腹痛、腹胀、便秘与腹泻反复发作的临床表现就诊,X线钡剂灌肠显示结肠脾曲较高,不同程度成角、狭窄或扭转,左结肠空虚萎缩而右半结肠胀大积粪。手术方法 :13例行结肠脾曲松解术、6例行横结肠部分切除术、2例行结肠次全切除术。术后半年内、一年内发生腹痛、腹胀、便秘与腹泻的例数分别为7例和4例。术后2年随访,19例大便通畅、食欲良好、体重增加、腹痛腹胀消失,属恢复良好;2例恢复不良:包括1例行结肠脾曲松解术术后便秘无改善,1例行近段结肠大部切除术后因抑郁症术后腹胀症状无改善。结论对于长期的、找不到原因的慢性不全性肠梗阻,手术可能是解决问题的重要方法 。

Objective To evaluate the outcomes of operation for patients with undetermined incomplete chronic intestinal obstruction and non-operation history. Methods Twenty-one cases of chronic intestinal obstruction were included in the study from May 2000 to May 2014. The clinical date and surgical outcomes were retrospectively reviewed. Results Clinical manifestation of the patients was unspecific symptoms. The main symptoms at the presentation were abdominal pain,abdominal distension, vomiting, constipation and emaciation. Barium enema examination showed high and angled splenic flexure（〈60°）, stenosis and twisting of colon,ectocolon with dry stool. The patients underwent lysis of splenic flexure of colon in 13 cases,part transverse colon resection in 6cases,subtotal colectomy in 2 cases. Seven cases（16.2%） complained abdominal pain,diarrhea,abdominal distention, and constipation in a half year ＇s follow-up after operation, and four had in one year after operation. Surgery had no effect on two cases and their complaint failed to relieve.Conclusion Surgical treatment should be a safe and feasible approach for undetermined origin of chronic incomplete intestinal obstruction.