对妊娠期肠梗阻误诊的探讨和13例临床分析

Misdiagnosis of intestinal obstruction in pregnancy and clinical analysis in 13 cases

目的分析妊娠合并肠梗阻的临床特点,并对误诊原因进行分析,以期指导临床早期诊断、早期治疗,减少母儿不良结局发生。方法收集在新疆医科大学第一附属医院产科就诊的妊娠合并肠梗阻患者13例,入院时间2017年7-12月,总结其临床特点,分析其诊治经过及结局,讨论妊娠肠梗阻危险因素,并对其中误诊为子宫破裂的一例特殊病例的特点和诊疗经过进行分析,总结经验。结果13例患者年龄25~30岁;发病孕周28周以上3例,28周以下10例;13例既往均有腹部手术史,次数1~3次。症状为腹部疼痛及腹胀感、恶心呕吐、停止排气排便或不畅,一例患者出现感染性休克脓毒症症状;11例患者保守治疗,2例患者手术治疗。其中一例患者误诊为子宫破裂,术中发现为“肠梗阻,腹内疝伴坏疽、肠坏死”。结论妊娠合并肠梗阻临床表现有时不典型,易误诊,延迟诊断、延误治疗可导致孕产妇和围生儿不良结局。既往腹部手术史是发生肠妊娠合并肠梗阻的高危因素。早期诊断、早期治疗,制定适宜方案,对保守治疗无缓解者应及时给予手术治疗是提高疗效的关键,可以明显减少并发症、改善母胎结局。

Objective The study is to explore and analyze the clinical characteristics of pregnancy complicated with intestinal obstruction,and analyze the causes of misdiagnosis,so as to guide the early clinical diagnosis and treatment,and reduce the adverse outcomes of mothers and fetuses.Methods 13 cases of pregnancy complicated with intestinal obstruction treated in the obstetrics department of our hospital from July 2017 to December 2017 were reviewed,their clinical data were analyzed,the clinical features and risk factors of intestinal obstruction during pregnancy were analyzed.The clinical characteristics and diagnosis and treatment process of one case misdiagnosed as uterine rupture wasanalyzed.Results 13 patients were 25-30 years old.There were 3 cases with gestational age over 28 weeks and 10 cases with gestational age under 28 weeks.All the 13 patients had a history of abdominal surgery(1-3 times).The clinical manifestations were abdominal pain,abdominal distension,nausea and vomiting,cessation of defecation.Furthermore,septic shock and sepsis happened in one patient.For 11 patients were treated conservatively,2 patients were treated by surgery.A patient was misdiagnosed as uterine rupture,and“intestinal obstruction,internal hernias with gangrene andintestinal necrosis”was found during her operation.Conclusion The clinical diagnosis of pregnancy complicated with intestinal obstruction is difficult and easy to be misdiagnosed.Previous abdominal surgery is a risk factor for intestinal obstruction during pregnancy.Early diagnosis,early treatment,formulation of appropriate programs,and for the patient of conservative treatment without remission,surgical treatment should be timely implemented,which is the key to improve the effectiveness,and can significantly reduce the incidence of maternal and fetal complications.