粘连性肠梗阻168例临床治疗分析

Clinical treatment analysis of 168 cases with adhesive intestinal obstruction

目的探讨粘连性肠梗阻的治疗方法及临床效果。方法选取2011年1月至2015年1月肠梗阻患者168例,其中经保守治疗无效后接受手术治疗者48例。48例中行腹腔镜探查肠粘连松解32例,行剖腹探查肠粘连松解16例。将48例患者分为早期手术（≤36 h）、中期手术（36~72 h）及晚期手术（≥72 h）,分析其手术效果及预后。结果 48例中早期手术20例,中期手术14例,晚期手术14例。接受手术治疗的48例患者中,1例晚期手术的患者术后6 d出现梗阻（肠扭转）,经再次手术后治愈,1例晚期手术患者术后切口感染,经换药后切口愈合良好,2例1年内出现肠梗阻经保守治疗缓解,余均顺利痊愈出院。结论胃肠外科中以肠梗阻的病因最为复杂,病情变化快,现在腹腔镜技术普及面广,适当放宽手术指征,早期腹腔镜手术干预可减少并发症,降低病死率。

Objective To investigate the effects and treatment methods of adhesive intestinal obstruction. Methods From Jan. 2011 to Jan. 2015,168 patients with adhesive intestinal obstruction were selected,in which 48 cases were treated with surgery after invalid conservative treatment. In 48 cases,32 cases underwent laparoscopy exploration and laparoscopy enterolysis,16 cases underwent exploratory laparotomy and adhesion lysis. According to the time of the patients from admission to hospital to undergo surgery,these patients were divided into early surgery（ ≤36 h）,mid-term surgery（ 36-72 h）,late surgery（ ≥72 h）,the surgery effect and the prognosis were analyzed. Results Early surgery with 20 cases,mid-term surgery with 14 cases,late surgery with 14 cases. Among the 48 cases,one case in late surgery got intestinal obstruction（ volvlus） on the sixth day after operation was treated with second surgery and healed,one case with late surgery had incision infection and healed well after wound dressing,and 2 cases got intestinal obstruction in one year were treated conservativey. The orther patients were all recovery.Conclusion The cause of intestinal obstruction is complicated and the change of the patient＇s condition is rapid,nowdays laparoscopic technique is widely applied,the indications of operation may not be strictly obeyed,early laparoscopic surgery could reduce the complications and fatality.