急性结肠梗阻的诊断与治疗

Diagnosis and management of acute large bowel obstruction

目的:探讨急性结肠梗阻的诊断、围手术期处理及手术方式的选择。方法:回顾分析我院1991年1月～1997年11月间手术治疗的急性结肠梗阻57例。结果:癌性结肠梗阻占71.9％(41/57),而术前确诊率仅31.7％(13/41)。术前选用预防性抗生素静滴,术中行肠减压及结肠灌洗,行Ⅰ期切除手术44例,占77.2％(44/57),同时Ⅰ期吻合36例,占81.8％(36/44),其中左半结肠病变者占55.6％(20/36),无死亡及吻合口漏发生。结论:对急性结肠梗阻应加强术前诊断和认识,完善术前术中处理是降低Ⅰ期肠切除和吻合术后并发症和死亡率的关键.

Objective: The purpose of this study was to evalute the diagnosis,perioperative management, and procedure’s choice of acute large bowel obstruction (ALBO). Methods:57 cases of ALBO operated upon between Jan. 1991 and Nov. 1997 were reported, and related problems were discussed. Results:There were 41 cases(71. 9%,41/57)of acute carcinomatous colonic obstruction(ACCO)among them,but the pre - operative diagnosis rate of ACCO was only 31. 7% (13/41). Through protective antibiotic intravenation and on-table proximal decompression or/and lavage, 44 patients (77. 2%) underwent single - stage resection,of whom 36 patients (81. 8%)underwent primary anastomosis including 20 cases of left colonic leision. In this group,there were no deaths and leaks. Conclusion: We believed that it was the key to enhance pre - operative diagnosis or recognize and perioperative manatement of ALBO for decreasing mortality and mirbidity of single -stage resection and anastomosis.