术后肠梗阻的研究现状与展望  

Research status and perspective of Postoperative ileus

作　　者：钟鉴宏[1] 苏家勇 马良[1] ZHONG Jianhong;SU Jiayong;MA Liang(Hepatobiliary Surgery Department,Guangxi Medical University Cancer Hospital,Nanning,Guangxi 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院肝胆外科,广西南宁530021

出　　处：《中华全科医学》2023年第9期1576-1580,共5页Chinese Journal of General Practice

基　　金：国家自然科学基金项目(82060510,82260569);广西科技基地和人才专项(桂科AD22035057);广西中医药适宜技术开发与推广项目(GZSY23-66)。

摘　　要：术后胃肠功能恢复障碍甚至肠梗阻(postoperative ileus,POI)是腹腔手术后常见的并发症,发生率为10%左右。POI是指在手术干预后由非机械原因引起的胃肠协调运动的短暂停止,进而阻碍胃肠道内容物的有效转运或影响口服摄入的耐受,表现为腹胀、压痛、未闻及肠鸣音。POI的特征是由于非机械性原因导致的手术干预后暂时的胃肠动力抑制,影响正常饮食。POI及其导致的围手术期其他并发症降低了患者的舒适度,可延长患者术后住院时间,显著增加住院费用。POI的病因呈多样性,发病机制较复杂,主要涉及损伤部位释放炎症介质、抑制性神经反射和药理学机制。POI发生的危险因素包括老年、开放手术、手术难度大、手术时间超过3 h、术前未进行肠道处理、感染或需要输血等。POI重在预防,包括术前、术中和术后的干预措施。微创手术和多模式镇痛治疗方案可减少POI的发生。围绕预防术后POI的发生和缩短POI持续时间,近十年已有很多临床研究探索了不同的干预方法。目前快速康复外科指南推荐的方案主要有微创外科、早期肠内营养、咀嚼口香糖、术前口服泻药和阿维莫泮等,对促进患者术后胃肠功能的恢复、减少POI的发生、缩短术后住院时间等均有一定的作用。Postoperative gastrointestinal dysfunction and even postoperative ileus(POI)are common complications after abdominal surgery,with an incidence rate of about 10%.POI is a temporary non-mechanical cessation of gastrointestinal coordination following surgical intervention that prevents effective transport of gastrointestinal contents or tolerates oral ingestion,manifested by bloating,tenderness,and no noise of borborygmus.POI is characterized by temporary gastrointestinal motility suppression after surgical intervention due to non-mechanical causes,affecting normal diet.POI and its associated perioperative complications reduce patient comfort,prolong the length of hospital stay and significantly increase the cost of hospitalization.The etiology of POI is diverse and its pathogenesis is complex,mainly involving the release of inflammatory mediators at the injured site,inhibitory neural reflex and pharmacological mechanism.Risk factors for POI include old age,open surgery,difficult surgery,surgery longer than 3 hours,no bowel treatment before surgery,infection,or the need for blood transfusion.POI focuses on prevention,including preoperative,intraoperative and postoperative interventions.Minimally invasive surgery and multimodal analgesic therapy can reduce the incidence of POI.In the past decade,many clinical studies have explored different intervention methods to prevent the occurrence and shorten the duration of POI after surgery.Current guidelines for enhanced recovery after surgery mainly recommend minimally invasive surgery,early enteral nutrition,chewing gum,preoperative oral laxatives and alvimopan,which have certain effects on promoting postoperative gastrointestinal function recovery,reducing the occurrence of POI and shortening postoperative hospital stay.

关 键 词：术后肠梗阻 快速康复外科 术后住院时间 

分 类 号：R619[医药卫生—外科学]