剖宫产术后急性结肠假性梗阻1例报告并文献复习

Acute colonic pseudoobstruction following cesarean section:one case report and review of the literature

目的探讨剖宫产术后急性结肠假性梗阻(ACPO)的发病相关因素、临床表现、诊断、治疗及预后。方法回顾分析中国医科大学附属盛京医院2019-09-02收治的1例剖宫产术后急性结肠假性梗阻的临床资料,在PubMed、EMBASE、Google上进行无语言限制的相关电子文献检索,对相关文献进行分析总结。结果患者34岁,妊娠合并癫痫,孕足月择期剖宫产,术程顺利,剖宫产术后48h出现腹胀,术后70h出现腹痛伴呼吸费力,完善全腹CT提示中腹部部分小肠壁增厚、强化,右半结肠积气、积液扩张,肠梗阻,予以保守治疗未见好转后行急诊手术。术中见结肠显著扩张,未见明显占位性病变,予行横结肠双腔造瘘术。回顾历史文献共检索到75例剖宫产术后的急性结肠假性梗阻病例,最常见的症状是腹胀,其次分别为腹痛、呕吐、发热、恶心,还有极少部分人出现腹泻。52例报道年龄,患者年龄为19~42(30.77±6.02)岁,其中高龄产妇(年龄≥35岁)为15例。47例报道了术后出现症状时间,为2.0(1.0,3.0)d。70例病例可查阅到治疗方式,保守治疗成功率为48.6%(34/70),病死率为2.7%(2/75)。结论对于剖宫产术后ACPO患者应予以重视,保守治疗通常有效,对于复杂病例或保守治疗无效的病例应行手术治疗。

Objective To explore the cause,clinical characteristics,diagnosis,treatment and prognosis of acute colonic pseudoobstruction(ACPO)following cesarean section.Methods One case of acute colonic pseudoobstruction following cesarean section at Shengjing Hospital of China Medical University(2019-09-02)was analyzed retrospectively.A systematic search was performed to identify articles investigating the aetiology and pathophysiology of ACPO from databases-PubMed,EMBASE and Google,and the related literatures were analyzed and summarized.Results A 34-year-old female complicated with epilepsy during pregnancy underwent an elective caesarean section at the full term of pregnancy.The operation was done smoothly.After 48 hours the patient complained about abdominal distension.After 70 hours,she had abdominal pain with dyspnea.Abdominal computed tomography agiography(CTA)was performed,which revealed that there was thickened wall of the small intestine,distension(with air-fluid levels)of the right half of the colon and intestinal obstruction.Symptom was not relieved by the conservative treatment.She proceeded to have an emergency exploratory laparotomy with a double-barrel stoma.No significant expansion of the colon or space occupation were found during the operation.A total of 75 reported cases of ACPO following cesarean section were retrieved from the historical literature,which often showed abdominal distention,followed by abdominal pain,vomiting,fever,nausea,and diarrhea in a few patients.Age was reported in 52 cases,and the age of the patients was 19-42(30.77±6.02)years old,15 cases among whom were over 35 years old.The onest time of postoperative symptoms was reported in 47 cases,which was 2.0(1.0,3.0)days.The treatment methods were mentioned in 70 cases:the success rate of conservative treatment was 48.6%(34/70),and the mortality ratew as2.7%(2/75).Conclusion We should pay attention to the patients with acute colonic pseudoobstruction following cesarean section.Conservative treatment was usually effective.Surgical treatment should be reserved for the complicated cases or the cases with ineffective conservative treatment.