腹部术后早期肠梗阻再手术治疗21例分析

目的探讨腹部术后早期肠梗阻的原因，总结再手术的经验。方法回顾分析2005年1月2010年6月21例腹部术后早期肠梗阻再手术患者的临床资料。结果21例术后早期肠梗阻出现时间为术后4～11d，经再手术明确梗阻原因，术中证实粘连性肠梗阻12例，漏诊消化系统肿瘤3例，漏诊直肠癌1例，陈旧性粘连带致肠管卡压2例，遗漏多发肠石1例，合并急性阑尾炎、阑尾周围脓肿合并肠粘连梗阻2例，合并肠套叠1例。1例粘连性肠梗阻为术后17d再次手术，由于无法找到明确的梗阻点，故行梗阻远近两端侧侧吻合术，术后25d梗阻解除；其余20例经再手术后3～5d梗阻均解除，无手术死亡病例。结论腹部术后早期肠梗阻多见为肠粘连。充分的术前准备，规范的手术操作，严密的术后观察，可减少粘连性肠梗阻的几率。选择适宜的手术方式，精确细致的手术操作是再手术成功的关键。

Reasons for Reoperation in 21 Cases of Early Postoperative Intestinal Obstruction

Objective To analyze the reasons for reoperation for early postoperative intestinal small obstruction, and summarize the experience of reoperation and treatment. Methods The reasons for reoperation in 21 patients with early postoperative intestinal small obstruction treated in our hospital from Jan 2005 to June 2010 were retrospectively analyzed. Results The 21 cases of early intestinal obstruction were occurred from 4 to 11 days after operation. By re-operating these 21 patients, the reasons for early postoperative intestinal small obstruction were clear. 12 of 21 cases were adhesive intestinal obstruction,3 of 21 cases with digestive system cancer were missed diagnosed, l case with rectum cancer was missed diagnosed, 1 case with multiple intestinal stones was missed. And 2 cases with old intestinal adhesions and compression were diagnosed,2 cases with acute appendicitis, the appendix abscess combined adhesive intestinal obstruction was diagnosed, and 1 case with intussusception was diagnosed. 1 of 21 cases with adhesive intestinal obstruction underwent reoperation at the 17th day after operation by side obstruction anastomosis near and far ends. The rest 20 cases were relieved at 3 to 25 days after reoperation. There was no death case. Conclusion Most of early postoperative intestinal obstruction is intestinal adhesion. The incidence of adhesive intestinal obstruction may be decreased by sufficient preoperative preparation, standard operation procedure and rigorous postoperative observation. The critical factors for success in reoperation are appropriate operation method and precise intraoperative procedure.