36例腹内疝致急性肠梗阻的临床特点分析

Clinical analysis of 36 cases of acute ileus caused by internal hernia

目的分析腹内疝致急性肠梗阻患者的临床资料,总结临床特点.方法回顾性分析北京大学第一医院2015年7月至2018年7月经手术证实的36例腹内疝致急性肠梗阻患者的临床资料.结果36例腹内疝患者均有急性肠梗阻的“痛、吐、胀、闭”症状,27例有明显压痛,9例有明显腹膜刺激征,6例有发热,术前所有患者均行腹盆腔平扫CT检查,其中26例影像学征象考虑腹内疝(72.2%).所有患者均经手术证实,其中粘连性腹内疝29例(80.6%),有15例(41.7%)出现肠坏死,肠坏死组与无肠坏死组相比除年龄外,在术前症状、体征及辅助检查方面差异均无统计学意义(P>0.05).结论腹内疝致急性肠梗阻临床表现缺乏特异性,腹盆部CT有助于协助诊断,其中粘连性腹内疝最为常见,多与腹盆部手术相关,肠坏死早期难以识别,应积极手术干预.

Objective To analyze ihe clinical data of acute ileus caused by internal hernia and to summarize its clinical characteristics.Methods Hie clinical data of 36 patients with acute ileus caused by internal hernia confirmed by operation in our hospital from July 2015 to July 2018 were analyzed retrospectively.Results 36 patients with internal hernia showed the symptoms of"pain,vomiting,distension and closure"of acute intestinal obstruction,27 cases had obvious tenderness,9 cases had obvious peritoneal irritation,and 6 cases hud fever.All the patients underwent abdominal and pelvic-CT examination pre-operation,and 26 of them(72.2%)made the diagnosis of internal hernia.All the patients were confirmed by surgery,the most common type of internal hernia was adhesive internal hernia,accounted for 29 cases 80.6%.and 15 cases(41.7%)showed intestinal ischemic-necrosis.There was no statistical difference in preoperative symptoms,signs and auxiliary examinations between the intestinal necrosis group and the group without intestinal necrosis,except for age.Conclusion The clinical manifestations of acute ileus caused by internal hernia are lack of specificity,and ul>dominul and pelvic CT can be used to assist the diagnosis.The adhesive internal hernia is the most common type,most of which is related to alxlominal and pelvic surgery,and the intestinal necrosis is difficult to identify at the early stage,surgical intervention should be taken actively.