剖宫产术后急性结肠假性梗阻11例临床分析  

Acute colonic pseudo-obstruction after cesarean section:a retrospective analysis of 11 cases

作　　者：彭影 彭程[1] 蒋来 李跃波 万安 陈玲[1] Peng Ying;Peng Cheng;Jiang Lai;Li Yuebo;Wan An;Chen Ling(Department of Obstetrics and Gynecology,the First Affiliated Hospital of University of Science and Technology of China; Anhui Provincial Hospital,Hefei 230001,China)

机构地区：[1]中国科学技术大学第一附属医院安徽省立医院妇产科,合肥230001

出　　处：《中华围产医学杂志》2019年第1期35-40,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的总结剖宫产术后急性结肠假性梗阻(acute colonic pseudo-obstruction,ACPO)的影响因素、临床特点及治疗经验。方法2006年1月至2018年1月中国科技大学第一附属医院诊断剖宫产术后ACPO的患者11例,作为病例组纳入研究。按照与病例组5∶1比例选择剖宫产术时间相差不超过2周的剖宫产术后未发生ACPO者作为对照组,共55例。回顾病历资料,比较2组病例的临床特点,分析剖宫产术后ACPO的危险因素。采用成组t检验、χ2检验及logistic回归分析进行统计学分析。结果病例组11例患者中分别有1、7、2例于术后2、3和4 d出现腹胀,另1例于术后17 d出现腹胀,均伴有腹痛、恶心,部分患者有呕吐。腹部X射线平片均提示结肠积气扩张,可见结肠袋形,最大盲肠直径6~12 cm,2例患者伴气液平面。所有患者均予禁食水、胃肠减压、静脉补液、纠正电解质紊乱、高渗盐水灌肠、预防感染等处理。8例患者经保守治疗后病情缓解,3例保守治疗无效予手术治疗。病程2~6 d。手术治疗的3例患者最大盲肠直径均≥9 cm,其中1例病情进展较快,不能排除机械性肠梗阻,行开腹探查,穿刺肠管排气效果不佳,经肛门置入胸腔导管成功减压;1例因保守治疗4 d,病情无缓解,腹膜刺激征阳性,行结肠造瘘术;1例保守治疗5 d病情反复,因肠穿孔行回盲部切除+升结肠远端封闭+末端回肠造瘘术。多因素logistic回归分析显示,术后白细胞计数(OR=1.38,95%CI:1.12~1.71,P=0.003)和术后体温>38℃(OR=6.47,95%CI:1.06~39.61,P=0.044)是剖宫产术后ACPO的危险因素。结论剖宫产术后白细胞计数高、体温>38℃是ACPO的危险因素。ACPO起病急,首选保守治疗;如无效,尤其当最大盲肠直径≥9 cm时易出现肠坏死或穿孔,需积极手术治疗。ObjectiveTo summary the risk factors,clinical characteristics and treatment of acute colonic pseudo-obstruction(ACPO)after cesarean section(CS).MethodsThe case group enrolled 11 patients who were diagnosed with ACPO after cesarean section in the First Affiliated Hospital of University of Science and Technology of China from January 2006 to January 2018.Another 55 patients without ACPO after CS,performed within two weeks'difference from the case group,were randomly selected as the control group.Clinical data of all subjects were analyzed retrospectively.Potential clinical risk factors were statistically analyzed.T test,Chi-square test and logistic regression analysis were used for statistical analysis.ResultsIn the case group,the abdominal distension presented on 2 d(n=1),3 d(n=7),4 d(n=2)and 17 d(n=1)respectively after CS,and all cases experienced abdominal pain and nausea.Vomiting was reported in some cases.Plain abdominal X-ray images revealed pneumocolon with colon pouch.The maximum diameter of cecum was 6 to 12 cm.Air-liquid levels were observed in two patients.All patients underwent fasting,gastrointestinal decompression,intravenous fluid infusion,correction of electrolyte imbalance,hypertonic saline enema and prophylactic antibiotic treatment.The disease condition lasted two to six days in these patients.Conservative treatment was successful in eight patients and failed in the other three who later went for operations.The maximum cecal diameters in the three patients who underwent surgery were all≥9 cm,among whom one case progressed quickly and laparotomy was tempted to rule out mechanical intestinal obstruction.In this case,the pressure was successfully reduced by placing a thoracic catheter through the anus after the failure of intestinal puncture trying to release the gases.One patient underwent colostomy due to positive signs of peritoneal irritation after a failure of four-day conservative treatment.One patient suffered a relapse after having been treated conservatively for five days,and then underwe

关 键 词：剖宫产术 手术后并发症 结肠假性梗阻 肠穿孔 

分 类 号：R719.8[医药卫生—妇产科学]