胃术后机械性梗阻手术探查80例分析  

Eighty cases analysis of exploratory for mechanical obstruction after gastric operations.

作　　者：詹文华[1] 卢光宇[1] 王吉甫[1] 

机构地区：[1]中山医科大学附属第一医院胃肠外科,510080

出　　处：《中国实用外科杂志》1994年第2期82-84,共3页Chinese Journal of Practical Surgery

摘　　要：作者报告经手术探查的胃术后梗阻80例。原术式:B-Ⅱ胃切除73例,胃空肠吻合7例。急性梗阻58例,慢性不完全性梗阻22例。最常见症状为呕吐、上腹饱胀、并有反复胃肠减压史,X线钡餐检查符合率90.4%。手术探查发现有明确机械性梗阻原因者72例。梗阻最常见的部位为输出袢(46/72),其次为输入袢(16/72)。梗阻原因以粘连最为多见(37/72)。内疝(11/72)、大网膜团块(10/72)及横结肠系膜裂孔疤痕缩窄(8/72)也较常见。除内疝病例外,本组非手术治疗时间最短为一周。最常用的手术方法是粘连松解、Braun's吻合及内疝复位。手术后59例症状消失:主要症状消失,但有上腹饱胀10例;症状无改善7例,全组死亡4例。该文强调非手术治疗不能缓解的胃术后梗阻宜积极采用手术治疗。From 1962 to 1990, 80 patients who failed to respond to conservative therap underwent further abdominal exploration because of obstruction after gastric operations. Of 80 patients, 73 cases had recieved Bill-11 gastrectomy, and 7 cases had recieved gastrojejunostomy as primary surgical procedures. 58 cases presented as acute obstruction, 22 cases chronic and incomplete obstruction. The most common clinical features include vomiting, epigastric fullness and vague pain. The most patients had the history of repeated nasogastric sucking. The diagnosis of obstruction was suported by X-ray upper gastrointestinal examination in 90.4% of all patients. The verified mechanical obstruction was found in 72 cases, the common sites of obstruction were the efferent loop (46/72), amd afferent loop (16/72). The etiologic factors involved adhesion (37/72), internal herniation (11/72), Omental neccrosis (10/72), and cicatricial contracture of transverse mescolon (8/72). The precedures commonly used were lysis of adhesions, Braun'anastomosis, and redution of hernia. The symptoms of obstruction disapeared after reoperation in 59 cases, the postoperative death occurred in 4 cases. The authors emphasized htat surgical intervation should not be delayed if the patients failed to respond to conservative management.

关 键 词：胃切除 手术后 机械性梗阻 并发症 

分 类 号：R656.610.6[医药卫生—外科学]