无腹部手术史的腹内疝致肠梗阻23例诊治分析  

Diagnosis and treatment analysis of 23 intestinal obstruction patients caused by intra-abdominal hernia with no abdominal surgery history

作　　者：曹双军[1] 石庆龙[1] 王红禄[1] 任正华[1] 赵雪松[1] 方磊[1] 

机构地区：[1]首都医科大学良乡教学医院普外一科,北京市102401

出　　处：《中国基层医药》2014年第10期1479-1481,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：通过对无腹部手术史的腹内疝致肠梗阻病例的诊治分析，提高对腹内疝致肠梗阻的认识。方法对23例无腹部手术史的腹内疝所致肠梗阻患者临床资料进行回顾分析。分析腹内疝致肠梗阻的临床表现、类型及发病因素，并对其诊治及预防进行讨论。结果全组患者由肠血液循环障碍引起，其中小肠肠系膜裂孔疝11例，十二指肠旁疝2例，盲肠旁疝2例，大网膜裂孔疝3例，闭孔疝1例，先天性肠管发育不良和扭转致小肠系膜疝2例，腹腔内单纯束带形成压迫肠管2例。患者中8例出现肠坏死。22例经手术治疗后痊愈，1例死亡，12例患者术后出现并发症。出现肠坏死患者术后并发症发病率为59．3％（切口感染37.1％，肺炎22．2％），明显高于无肠坏死组的11．8％（切口感染5．9％、肺炎5．9％）（χ^2＝3．861、3．861，均P＜0．05）。结论无腹部手术史的腹内疝致肠梗阻为闭襻性肠梗阻，术前诊断困难，病情发展迅速，不及时手术治疗短期内可出现肠绞窄、肠坏死。故早期诊断、及时手术治疗是诊治无腹部手术史的腹内疝致肠梗阻的关键。Objective To analyze the diagnosis and treatment of intestinal obstruction patients caused by intra-abdominal hernia with no abdominal surgery history ,in order to raise awareness .Methods Clinical data of 23 intestinal obstruction patients caused by intra-abdominal hernia with no abdominal surgery history were retrospectively analyzed.The clinical manifestations ,type,and risk factors were analyzed .And its diagnosis and prevention was dis-cussed.Results 23 patients were caused by intestinal blood circulation disorders ,in which there were 11 cases small intestine mesentery hernia ,2 cases duodenal hernia ,2 cases pericecal hernia ,3 cases omentum hernia ,1 case obturator hernia,2 cases congenital dysplasia and intestinal mesenteric torsion induced small hernia ,2 cases formation of intra-abdominal pressure alone belted intestine ,8 cases of intestinal necrosis .22 patients were cured after surgery ,1 case died,12 cases had postoperative complications .The incidence rate of postoperative complications of patients with in-testinal necrosis was 59.3%（ wound infection 37.1%, pneumonia 22.2%）, which was significantly higher than 11.8%of patients without intestinal necrosis （wound infection 5.9%,pneumonia 5.9%）（χ^2 =3.861,3.861,all P〈0.05）.Conclusion The intestinal obstruction caused by intra-abdominal hernia with no abdominal surgery history is closed loop obstruction , preoperative diagnosis is difficult , with the rapid progression of the disease , and intestinal strangulation ,intestinal necrosis can occur in the short term whithout timely surgical treatment .Therefore ,early diagno-sis and prompt surgical treatment is the key to the diagnosis and treatment of intestinal obstruction caused by intra -ab-dominal hernia with no abdominal surgery history .

关 键 词：疝 腹部 肠梗阻 诊断 治疗学 

分 类 号：R656.2[医药卫生—外科学]