重视急性肠梗阻诊断和治疗规范化

Challenges in the diagnosis and management of acute bowel obstruction: Focus on the standard of practice

急性肠梗阻是最常见的外科急腹症之一,其病因复杂、病情常危急多变。对不同类型肠梗阻的临床病理学特征认识不足、对特殊类型肠梗阻的危急性重视不够、对影像诊断的过度依赖和不恰当的诊疗决策是目前存在的主要问题。临床上,应从规范病史采集、理学诊断和特殊临床表现的病理学机制解读等环节着手,强化年轻外科医生的基本功训练、规范选择影像诊断技术并合理解读检查结果,及早作出定性和定位诊断,明确其病因,排除绞窄性梗阻和闭襻性梗阻,及时准确评估病情变化;准确把握手术干预时机,并遵循损伤控制原则,合理选择手术方案。

Acute bowel obstruction(ABO)is one of the most common acute abdomen with complicated etiology and critical conditions.Insufficient recognition of the clinicopathologic features for different types and the urgency for special types of ABO,over-reliance on imaging diagnosis,and less standard for practice are the major limitations in the management of ABO. Basically,a qualified clinical training program,including history collection, physical examination and thorough comprehension of the pathological mechanisms,is needed to be established. Furthermore,application and interpretation of imaging examinations should be standardized,in order to achieve precise qualitative,topical and etiological diagnosis. Specifically,strangulated and closed loop ABO should be identified and treated very soon due to critical outcome. Finally,the strategy of surgery should be made based on the strict indications and damage control principle.