急性粘连性肠梗阻手术时机的探讨

目的探讨急性粘连性肠梗阻手术时机的选择。方法回顾性分析我院1998年1月～2003年12月经手术治疗的88例急性粘连性肠梗阻的临床资料。其中，因入院时即诊断肠绞窄而行急诊手术5例；先保守观察后手术治疗83例：腹部体征加重，辅助检查提示向绞窄性肠梗阻发展45例；造影剂24h内未能到达结肠12例；保守治疗4～5d无好转15例；肠梗阻反复发作11例。手术方式包括粘连松解术80例，坏死肠管切除吻合术4例，肠短路吻合术3例，小肠内固定术l例。结果术后发生肠外瘘1例，经保守治疗45d后痊愈；切口感染10例，经1T期缝合后治愈。结论急性粘连性肠梗阻在保守治疗过程中应及时发现早期肠绞窄的线索，果断决定手术治疗，手术时机宜早勿迟，手术指征宜宽勿严。

Timing of Surgery for Acute Adhensive Intestinal Obstruction

Objective To investigate the timing of surge ry for acute adhensive intestinal obstruction. Methods 88 cases of acute adhesive intestinal obstruction underwent surgical treatment from January 1998 to December 2003, of which the diagnosis of intestinal strangulati on established right at the admission in 5 cases; the rest 83 cases conservativ ely treated prior to surgery in which deteriorating abdominal sign indicated a t rend to develop intestinal strangulation in 45 cases; contrast medium delayed p roximal to colon for 24h in 12 cases; no sign of relief by conservative treatmen t in 15 cases, recurrent intestinal obstruction in 11 cases. The surgical method s included enterodialysis in 80 cases, enterectomy and anastomosis in 4 cases, i ntestinal short corcuit anastomosis in 3 cases and enteropexy in 1 case. Results External fistula occured in 1 case which was cured by 45 days of conservatively treatment, wound infection in 10 cases which cured by secondary suture. Conclusion Prompt surgical interventio n should be done in case with any sign of strangulation which ought to be identi fied as early as possible during conservative treatment.