术后早期炎症性肠梗阻七例诊治体会

术后早期炎症性肠梗阻虽不是一种新类型肠梗阻,但因其在诊治上具有特殊性,常误诊为机械性肠梗阻,处理不当会引起肠瘘、重症感染等并发症.现将我院1984～1999年收治的7 例报告如下.     

术后早期炎症性肠梗阻的诊断和治疗

术后早期炎症性肠梗阻 (earlypostoperativeinflammatorysmallbowelobstruction ,EPISBO)为腹部外科手术常见并发症之一。Stewart[1]报告术后早期发生的肠梗阻约占术后肠梗阻的 2 0 0 % ,其中 90 0 %是炎症性肠梗阻。由于原发病的不同 ,EPISBO的发病率波动在 0 0 6%～ 14 3 1%之间。EPISBO常反复发作 ,病程长 ,患者在发病前一般均接受过一次或多次手术 ,体质状况差。在临床表现和处理上均有其特殊性 ,如处理不当会引起肠瘘、短肠综合征、重症感染等严重并发症甚至死亡。笔者重点论述其诊断和治疗。1　概述EPISBO是指在腹部手…     

腹腔镜与开腹结直肠癌根治术术后早期炎症性肠梗阻的防治

目的 探讨腹腔镜与开腹结直肠癌根治术术后早期炎症性肠梗阻(early postoperative inflammatory intestinal obstruction,EPIIO)的发生率、发病原因.方法 对照同期同一组医师连续实施的232例腹腔镜结直肠癌根治术与251例开腹结直肠癌根治术,比较术后早期肠梗阻发病率及防治差异.结果 LS组中转开腹14例,中转开腹率为5.69%(14/246);LS组术后EPIIO的发病率为3.02%(7/232),6例保守治愈,1例手术治愈,OS组术后EPIIO的发病牢为7.97%(20/251),18例保守治愈,2例手术治愈,且均行小肠排列术,两组EPIIO的发生率差异有统计学意义(x2=5.60,P＜0.05).结论 腹腔镜手术可减少EPIIO的发生率;EPIIO应以保守治疗为主,当病情反复或出现肠绞窄表现时应及时手术治疗.     

术后早期炎症性肠梗阻16例诊治体会

目的 探讨术后早期炎症性肠梗阻的诊断和治疗。方法 对我院1995年至1999年间收治的16例术后早期炎症性肠梗阻患者的临床资料进行回顾性分析。结果 15例患者经胃肠减压、抗生素、理疗、肾上腺皮质激素及中药等治疗治愈,平均治疗时间11天,中转手术治疗1例,无1例肠坏死。结论术后早期炎症性肠梗阻的特点有：（1）多在手术后7天左右出现梗阻症状,多由腹腔内炎症所致广泛粘连引起;（2）症状以腹胀为主,腹痛相对较轻,较少发生肠绞窄;（3）治疗应首选非手术疗法。     

术后早期炎症性肠梗阻的发病机制与诊治进展

术后早期炎症性肠梗阻是一种机械性和动力性并存的粘连性肠梗阻,并且发生在腹部手术后早期,主要由手术创伤或腹腔内无菌性炎症等原因引发肠壁水肿及渗出而成。了解术后早期炎症性肠梗阻的病因、发病机制、临床表现、及诊治进展,有助于减少该病的发病率和提高该病的治愈率。本文就此作一综述。     

结直肠癌术后早期炎性肠梗阻诊断与治疗的临床体会(附23例报告)

目的总结结直肠癌术后早期炎性肠梗阻的临床特点和治疗措施。方法回顾分析2007~2013年23例结直肠癌术后早期炎性肠梗阻的诊治方法。结果本组23例患者均采用非手术治疗方法治愈。结论正确认识术后早期炎症性肠梗阻的特点是治疗的关键,明确诊断后应采用非手术治疗,多能获得满意结果。     

术后早期炎症性肠梗阻的治疗

目的：探讨术后早期炎症性肠梗阻的治疗。方法：回顾性分析21例术后早期炎症性肠梗阻的临床资料。结果：手术治疗10例，术后症状完全缓解6例，术后再次出现肠梗阻3例，术后并发肠瘘死亡1例。保守治疗11例均部分或完全缓解，平均治疗时间10．5d。其中2例出现慢性肠梗阻，1例出现反复发作的肠梗阻，此3例分别在术后3，4，6个月后行手术治疗。结论：术后早期炎症性肠梗阻的治疗原则应先行保守治疗。手术适应症为：（1）合并腹腔脓肿；（2）出现肠绞窄表现；（3）出现固定扩张的肠袢；（4）保守治疗治愈或缓解后出现慢性肠梗阻或反复发作的肠梗阻。前3项可早期手术，而后者以保守治疗3个月手术为宜。     

结直肠癌术后早期炎性肠梗阻的相关危险因素

目的:探讨结直肠癌术后早期炎性肠梗阻的发生及预防策略.方法:回顾性分析120例结直肠癌术后早期炎性肠梗阻患者的临床资料,对其发生的相关危险素进行单素及多素分析.结果:早期炎性肠梗阻与年龄(P=0.023)、手术方式(P=0.008)、腹部手术史(P=0.002)、肠道准备情况(P<0.001)、术中防粘连剂使用(P=0.006)、手术时间(P=0.042)有关;开腹手术(P=0.024)、有腹部手术史(P=0.034)及术前未行肠道准备(P=0.006)是结直肠癌术后早期炎性肠梗阻发生的独立危险素.结论:开腹手术、有腹部手术史及术前未行肠道准备是结直肠癌术后早期炎性肠梗阻发病的独立危险素.     

术后早期肠梗阻的诊治

目的探讨术后早期肠梗阻的诊断及治疗方法。方法对35例术后早期肠梗阻的临床特点和诊断治疗方法进行回顾性分析。结果35例术后早期肠梗阻均发生于术后1～2周内，保守治疗成功27例，肠梗阻缓解时间3～14天，平均8．3天；保守治疗无效后手术治疗8例，2例小肠于侧腹膜成角，2例小肠嵌顿于盆底腹膜，1例炎性肠梗阻合并上消化道穿孔，2例减张缝线缝合于小肠壁，1例为内疝形成。其中术后死亡1例。结论对术后早期肠梗阻应先行1～2周保守治疗，逾期无缓解者再行手术，这样可避免不必要的手术并减少术后并发症。     

术后早期炎症性肠梗阻65例临床分析

腹部手术后早期 (2周左右 )发生的肠梗阻 ,称之为术后早期炎症性肠梗阻 (简称炎性肠梗阻 ) [1] 。1988年 1月～ 1998年 12月 ,我院共诊治这一类型肠梗阻 6 5例 ,占同期各种类型肠梗阻 (82 3例 )的7 9% ,回顾分析如下。1　临床资料1 1　一般资料　本组 6 5例 ,其中男 51例 ,女 14例。年龄 2～ 74岁 ,平均 4 1岁。肠梗阻出现时间最早为术后 6 0ｈ ,最晚为 15ｄ ,平均 6 5ｄ。原发病及手术类型 :肠梗阻手术 2 0例 ,阑尾切除术 15例 ,肠穿孔修补术 14例 ,胃手术 5例 ,胆囊切除术及肝脾手术各 3例 ,嵌顿疝修补术 1例 ,肠道恶性肿瘤根治术及肠…     

腹腔镜结直肠癌术后住院期间肠梗阻的荟萃分析

目的用荟萃分析（meta—analysis）的方法对已发表的比较结直肠癌腹腔镜手术和开腹手术后住院期间肠梗阻发生率的临床研究进行定量分析。方法收集1989年1月-2008年3月公开发表的比较结直肠癌患者腹腔镜手术和开腹手术后住院期间肠梗阻的发生情况的所有随机对照研究（randomized controlled trials，RCT），按照荟萃分析的要求对检索到的原始研究的质量进行评估，对符合条件的所有研究结果进行荟萃分析，计算腹腔镜手术组相对开腹手术组发生肠梗阻危险的优势比（oddsratio，OR），评价腹腔镜手术和开腹手术对患者术后住院期间肠梗阻发生率的影响。结果符合纳入标准的共12篇文章，总样本量3032例。其中腹腔镜手术组1522例，发生住院期间肠梗阻33例；开腹手术组1510例，发生住院期间肠梗阻71例；合并OR=0．46，95％可信区间0．30～0．69。结论相对于开腹结直肠癌手术，腹腔镜结直肠癌手术可以降低术后住院期间肠梗阻的发生率。     

术后早期炎性肠梗阻诊治体会

目的探讨术后早期炎性肠梗阻的病因、临床特点及诊断与治疗。方法对我院40例腹部手术后早期炎性肠梗阻患者的诊断和治疗情况进行回顾性分析。结果全部患者症状缓解的时间为3～7d(平均5d)、住院时间为7～20d(平均13d)。随访时间为6～12个月(平均9个月),随访中有2例再次出现肠梗阻,经保守治疗治愈。结论术后早期炎性肠梗阻好发于腹腔污染重或创伤大的腹部手术,多发生于术后1～3周,肠梗阻症状和体征典型,很少发生肠绞窄坏死,保守治疗效果好。     

术后早期肠梗阻的诊断和治疗

目的探讨腹部手术后早期肠梗阻的病因、临床特点和治疗方法。方法回顾性分析24例腹部手术后早期肠梗阻病例的临床资料。结果 24例中20例经禁食、抗炎、解痉、肠外营养、胃肠减压等保守治疗痊愈,缓解时间平均7d;4例再次手术,1例为内疝,2例为肠管壁疝,1例为束带形成。结论术后早期肠梗阻的特点:①多于术后3～30d开始出现梗阻症状。②以炎性肠梗阻多见,腹胀为主,腹痛较轻,较少发生绞窄。为腹腔炎症引起黏连所致,大多经保守治疗有效。③少数病例为机械性因素造成梗阻,多需手术解除梗阻。对绞窄性梗阻应及早手术。再次手术宜从简,以解决梗阻为目的。     

Risk Factors for Early Postoperative Small Bowel Obstruction After Colectomy for Colorectal Cancer

Background  

Small bowel obstruction (SBO) after colectomy leads to markedly lower patient quality of life, longer hospital stays, and increased hospitalization costs. From a systemic treatment point of view, early postoperative SBO is one of the major concerns of the surgery because it often delays chemotherapy in advanced cases. The goal of this single-center study was to evaluate the risk factors for early postoperative SBO.     

Laparoscopic Treatment of a Postoperative Small Bowel Obstruction

We describe the case report of a 25-year-old female who presented with signs and symptoms of bowel obstruction status after laparoscopic treatment of an ectopic pregnancy performed 3 weeks earlier. The patient underwent laparoscopic lysis of adhesions and reduction of small bowel obstruction. This case report presents an atypical cause of postoperative bowel obstruction and reviews the current literature regarding laparoscopic surgery as an approach for treatment.     

腹部外科术后早期炎性肠梗阻的临床分析

为探讨腹部外科术后早期炎性肠梗阻的疾病特点和防治原则,回顾性分析36例术后早期炎性肠梗阻忠者的临床资料。结果显示,9例行手术治疗,术后并发肠瘘2例;其余27例均经保守治疗痊愈。结果表明,术后早期炎性肠梗阻应以保守治疗为主,胃肠外营养及生长抑索的应用具有较好的疗效。     

对大肠癌术后早期炎性肠梗阻诊治的探讨

目的：探讨大肠癌术后早期炎性肠梗阻的特点及治疗方法；方法：分析10例大肠癌术后出现早期炎性肠梗阻的临床表现并进行综合保守治疗；结果：10例患者保守治疗全部成功；结论：术后早期炎性肠梗阻是一种非细菌性炎性肠梗阻，以发生在术后早期，腹胀、呕吐明显，腹痛轻或无为主要临床特点，治疗应采用保守治疗。     

Early Postoperative Small Bowel Obstruction is an Independent Risk Factor for Subsequent Adhesive Small Bowel Obstruction in Patients Undergoing Open Colectomy

Background

This prospective study was performed to investigate whether postoperative ileus (POI) or early postoperative small bowel obstruction (EPSBO) affects the development of adhesive small bowel obstruction (SBO) in patients undergoing colectomy.

Methods

We prospectively enrolled 1,002 patients who underwent open colectomy by a single surgeon. POI was defined as the absence of bowel function for more than 5 days or as a delay in oral intake beyond 7 days postoperatively. EPSBO was defined as the clinical and radiologic identification of SBO after resuming oral intake between postoperative days 7 and 30. Adhesive SBO was defined as SBO developing after 30 days because of intraperitoneal adhesion. The associations between POI, EPSBO, patient- and surgery-related variables, and the development of adhesive SBO were analyzed.

Results

A total of 85 (8.5 %) patients developed POI, and 42 patients (4.2 %) developed EPSBO, with seven patients experiencing both POI and EPSBO. During the follow-up period (median 51 months), 70 patients (7.0 %) developed adhesive SBO, six (8.6 %) of whom needed laparotomy. The occurrence of adhesive SBO was significantly higher in patients with EPSBO than in those without EPSBO (26.5 vs. 7.5 % at 5 years, P < 0.001), but not in patients with POI (13.4 vs. 7.8 % at 5 years, P = 0.158). Multivariable analysis showed colostomy (hazard ratio [HR] 2.530, P = 0.006) and EPSBO (HR 4.063, P < 0.001) as independent risk factors for adhesive SBO.

Conclusions

The development of adhesive SBO after colectomy is more frequent in patients with EPSBO and colostomy; however, POI does not increase the risk of adhesive SBO.     

Predictors of Early Postoperative Quality of Life after Elective Resection for Colorectal Cancer

Introduction Measurement of quality of life (QoL) is assuming increasing importance in cancer care. Predictors of early postoperative QoL after colorectal cancer resection are not clear and the aim of this study was to identify these factors. Methods A consecutive series of eligible patients undergoing elective resection for colorectal cancer were invited to participate. Standardised, reliable and validated psychological questionnaires (HADS, PANAS, MRS, FACT-C, EQ-5D) were administered seven days prior to surgery and then six weeks after discharge. Results One hundred and four patients with colorectal cancer were recruited. There were 70 males (67.3%) and the mean age of the group was 67.6 years. Postoperative anxiety and depression were closely related to the preoperative anxiety and depression scores (p < 0.001). Other QoL scores also showed significant correlation with the respective preoperative scores. Anxiety, depression, and FACT functional wellbeing scores were also correlated with the incidence of postoperative morbidity. On multiple regression analysis postoperative morbidity, tumour node metastasis (TNM) stage, presence of stoma and preoperative QoL scores were found to independently predict postoperative QoL scores. Conclusion Routine preoperative QoL measurement in cancer patients can identify patients at risk of having a poor QoL postoperatively. Suitable psychological and pharmaceutical intervention can be planned in advance for this group.     

Laparoscopic Bowel Resection in the Setting of Metastatic Colorectal Cancer

Background This study aimed to review the outcomes of laparoscopic colorectal resection for patients with stage IV colorectal cancer. Methods From the prospectively collected database for patients who underwent surgery for colorectal cancer in our institution, those with stage IV colorectal cancer who underwent elective resection of tumor during the period from January 2000 to June 2006 were included. The outcomes of those with laparoscopic resection were reviewed and comparison was made between patients with laparoscopic and open resection. Results A total of 200 patients (127 men) with median age of 69 years (range: 25–91 years) were included, and 77 underwent laparoscopic resection. Conversion was required in ten patients (13.0%) and all except one conversion were due to fixed or bulky tumors. There was no operative mortality in the laparoscopic group. The complication rate was 14% and the median postoperative hospital stay was 7 days. When patients with laparoscopic resection were compared with those with open operations, there was no difference in age, gender, comorbidity, or tumor size between the two groups. However, the complication rate was significantly lower in those with laparoscopic resection (14% versus 32%, P = 0.007) and the median hospital stay was significantly shorter (7 days versus 8 days, P = 0.005).The operative mortalities and the survivals were similar in the two groups. Conclusions Colorectal resection can be performed safely in patients with stage IV colorectal cancer. The operative outcomes in terms of complication rate and hospital stay compare favorably with patients with open resection. Presented in the Scientific Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons on 18–22 April 2007 in Las Vegas, Nevada, USA.