87例急性小肠梗阻手术时机及术式探讨  

Investigation of the operative timing and method in 87 cases with acute small intestinal obstruction

作　　者：侯丁丁 王建方 秦春和 张子超 许建林 杨国山 赵力 HOU Dingding;WANG Jianfang;QIN Chunhe;ZHANG Zichao;XU Jianlin;YANG Guoshan;ZHAO Li

机构地区：[1]清华大学第一附属医院普外科,北京市朝阳区100016

出　　处：《中国研究型医院》2020年第5期49-52,共4页Chinese Research Hospitals

摘　　要：目的:探讨需行急诊手术治疗的急性小肠梗阻的手术时机及术式,为临床急性小肠梗阻手术治疗提供依据。方法:回顾性分析2014年9月~2020年1月,在清华大学第一附属医院普外科急诊手术治疗的87例急性小肠梗阻患者的临床资料。入组标准为急性小肠梗阻且需急诊手术治疗者,观察术后临床疗效及并发症情况,分析急诊小肠梗阻手术时机及术式。结果:87例急性小肠梗阻患者,73例行开腹手术,14例行腹腔镜下手术治疗,其中9例中转开腹,围术期无死亡病例,治愈85例,好转2例,2例术后出现肠漏,经非手术治疗后好转。结论:对于急性粘连性小肠梗阻一旦伴有急性弥漫性腹膜炎、腹水、肠穿孔、肠壁缺血或者无以上征象而行保守治疗12 h效果不佳等均为手术探查时机,而对于急性非粘连性小肠梗阻,一经发现,应尽早手术探查,小肠梗阻术式以开腹为主,腹腔镜手术需严格控制指征。Objective: To investigate the operative timing and method of acute small intestinal obstruction requiringemergency surgery in order to provide the basis for surgical treatment of acute intestinal obstruction. Methods:FromSeptember 2014 to January 2020, the clinical data of 87 patients with small intestinal obstruction requiring emergencysurgery in the General Surgery Department of the First Affiliated Hospital of Tsinghua University were retrospectivelyanalyzed. The inclusion criteria ware acute small intestinal obstruction requiring emergency surgery. The postoperativeclinical efficacy and complications were observed, and the operative timing and method of acute small intestinal obstructionrequiring emergency surgery were analyzed. Results: 87 cases of acute small intestinal obstruction were treated by surgery.73 cases were treated by laparotomy. 14 cases were treated by laparoscopic surgery, including 9 cases by laparoscopicsurgery converting to laparotomy. There were no deaths during the perioperative period, 85 cases were cured, 2 cases wereimproved, 2 cases occurred postoperative intestinal leakage which was cured after non-surgical treatment. Conclusion:Important indications of surgical exploration for patients with adhesive small intestinal obstruction who accompanied byperitonitis, bowel perforation, ascites, reduced enhanced bowel wall,mesenteric edema and after 12-hour ineffectiveconservative treatment without the above signs, and non-adhesion small intestinal obstruction should be early surgicalexploration. Operation is mainly confirmed by laparotomy, while laparoscopic surgery requires strict indications.

关 键 词：肠梗阻 小肠 外科手术 临床方案 

分 类 号：R656.7[医药卫生—外科学]