术后早期炎性肠梗阻的诊断和治疗

目的 对术后早期炎性肠梗阻的病因、诊断、治疗进行分析和探讨。方法 回顾分析26例术后早期炎性肠梗阻的临床资料及治疗效果。结果 26例均经禁食、胃肠减压、全肠外营养、应用糖皮质激素和生长仰素等方法治愈,平均治愈时间8.5天,无复发者。结论 术后早期炎性肠梗阻多发生在术后5～9天,可表现为典型的肠梗阻症状体征,采用非手术疗法治疗术后早期炎性肠梗阻效果满意。     

术后早期炎性肠梗阻

术后早期炎性肠梗阻常于腹部手术后1～3周内发病，约占术后早期肠梗阻的90％。该肠梗阻是由于肠壁水肿、炎性渗出和肠管间广泛粘连所致，故很少发生肠绞窄和肠坏死。虽病程较长，但多数可通过非手术治疗获得缓解治愈。若贸然再次手术，极易并发肠瘘，腹腔感染和短肠综合征等致命性并发症，死亡率高然29.4％。当然，在非手术治疗期间，要密切观察病情变化。一旦出现肠绞窄和腹膜炎等病情恶化迹象，应及时中转手术治疗。     

Extracorporeal detoxification by plasmapheresis in the complex treatment of acute intestinal obstruction

The article deals with problems of performing detoxication in complex treatment of acute ileus. A method of plasmapheresis is proposed for treatment of patients with a pronounced intoxication syndrome. Criteria for the estimation of the patient's state are presented which are considered as indications for extracorporal detoxication and for effectiveness of plasmapheresis both by clinical criteria of the estimation of the patient's state and by laboratory findings. High efficiency of the method is shown in complex treatment of patients with acute ileus with a pronounced intoxication syndrome.     

腹腔镜术后炎性肠梗阻60例临床分析

目的探讨腹腔镜术后早期炎性肠梗阻的临床特点、诊断依据、治疗原则及预后。方法对60例腹腔镜术后早期炎性肠梗阻患者的临床资料进行回顾性分析。结果 54例(90.00%)患者经保守治疗痊愈,6例(10.00%)行手术治疗后痊愈。患者均获平均(6±1.52)个月的随访,3例(5.00%)复发。结论腹腔镜术后早期炎性肠梗阻多发生于术后2周内,应采用多种检查手段综合分析,早期诊断并及时合理选择保守治疗或手术治疗,提高良好预后。     

Small intestine intubation for treatment of patients with peritonitis and intestinal obstruction]

The analysis of 36 case records of patients with peritonitis (n = 12) and intestinal obstruction (n = 24) is presented. Nasogastrointestinal intubation of the small bowel was used in combined treatment. The aims, indications and contraindications for the intubation are formulated. Bacteriologic and biochemical parameters of bowel content were studied. It was established that the quantity of enterobacteria and unfermenting gram-negative bacteria was increased in intestinal paresis, the alkaline phosphatase, amylase, bilirubin, transaminase, a potassium content were increased as well. For the tube to function from the first hours after its introduction it should be periodically properly washed with sodium hypochlorite in concentration 300 mg/l.     

Choice of a method of intestinal decompression for prevention and treatment of postoperative intestinal obstruction

Advantages of the intestine decompression in the prevention and treatment of postoperative obstruction were shown by an analysis of results of the treatment of 348 patients with acute surgical diseases of the abdomen. Lethality was reduced from 30,7% to 16,4%. The authors describe a modification of enterostomy after Maydle which has some advantages over other methods.     

腹腔内恶性肿瘤术后肠梗阻的治疗

目的:研究腹腔内恶性肿瘤术后肠梗阻的最佳治疗方法。方法:对我院自1994年8月～2002年7月八年间共收治的63例腹腔内恶性肿瘤术后肠梗阻进行回顾性研究。将63例患者依据梗阻原因的不同分为三组:原因暂时不明组、肠粘连组及肿瘤广泛转移组,对三组的治疗结果进行统计学分析。结果:肠梗阻原因暂时不明组17例,占总病例的27％,经保守治疗后,15例治愈,2例死亡。粘连性肠梗阻19例(30.2％),经剖腹手术13例,1例死亡,3例出现各种不同并发症;经腹腔镜手术6例。6例完全治愈,无1例并发症发生。肿瘤广泛转移致肠梗阻组27例,单纯化疗5例,治愈3例,死亡2例;剖腹手术或加化疗14例,2例死亡,4例发生各种不同并发症,治愈12例;经腹腔镜手术或加化疗8例,完全治愈,其中1例发生肺炎。在明确梗阻原因病例中,粘连性肠梗阻占41.3％,肿瘤广泛转移致肠梗阻占58.7％。腹腔镜手术或加化疗患者的并发症与剖腹手术或加化疗相比,降低有显著性差异,P<0.05。结论:腹腔内恶性肿瘤术后肠梗阻的最佳治疗方法应在保守治疗同时,明确病因,针对不同病因予以腹腔镜手术或加以化疗。     

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目的　总结术后早期炎性肠梗阻的治疗经验 ,提出诊断标准、治疗和预防措施。方法　回顾 73例炎性肠梗阻病人的治疗方法 ,包括禁食、胃肠减压、全肠外营养、糖皮质激素和生长抑素的应用。结果　 73例病人中治愈 72例 ,平均治愈时间为 (2 6 4± 11 6 )天 ,1例病人治愈后 18个月因机械性肠梗阻再次手术治愈 ,其余病人未再进行手术治疗 ,无复发者。结论　采用非手术疗法治疗术后早期炎性肠梗阻效果满意 ,并发症少 ,安全。手术治疗并发症多 ,疗效差。     

儿童腹部手术后早期炎性肠梗阻的诊治体会

目的 探讨儿童腹部手术后早期炎性肠梗阻的特点、诊断和治疗原则。方法 总结分析21例腹部手术后早期炎性肠梗阻临床特点、治疗方法及预防措施。结果 21例术后早期炎性肠梗阻均经胃肠减压，应用抗生素、肾上腺皮质激素、肠外营养支持，中药等治疗而治愈。平均治愈时间11．6d。结论 术后早期炎性肠梗阻多发生在术后1周左右，多为小肠炎性水肿粘连所致，应首选保守治疗。