术后腹腔粘连的诊断和治疗进展  

Progress in diagnosis and treatment of postoperative abdominal adhesions

作　　者：郝齐 许阳贤[1] Hao Qi;Xu Yangxian(Second Department of General Surgery,Long Hua Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200000,China)

机构地区：[1]上海中医药大学附属龙华医院普外二科,上海200000

出　　处：《国际外科学杂志》2024年第7期485-492,共8页International Journal of Surgery

基　　金：国家重点研发计划(2022YFC3500204);上海市自然科学基金项目(22ZR1462000)。

摘　　要：术后腹腔粘连,俗称术后肠粘连,是指由于手术损伤导致腹腔脏器间或腹腔脏器与壁腹膜异常粘连,是腹腔手术最常见的并发症。患者通常会出现腹痛腹胀、便秘,严重者表现为肠梗阻、肠坏死及女性不孕等症状,严重影响患者的生活质量,并且造成再次手术困难。目前术后腹腔粘连多以预防为主,而对于术后发生粘连相关症状的患者,仍没有可靠的诊断及治疗策略。当前诊断仍以手术探查为"金标准",也可以根据临床表现,结合超声、磁共振电影成像及部分实验室检查进行诊断,气腹CT腹膜腔三维仿真成像是一个有前景的诊断方式。虽然手术是公认有效的治疗方法,但是临床医师只有在应对严重的急性粘连性肠梗阻患者时才会首选手术干预,因此,目前对于术后腹腔粘连的治疗主要以包含中医药在内的非手术治疗方法为主。本文就术后腹腔粘连诊治过程中的相关进展进行综述,以期为临床诊疗提供新的思路。Postoperative abdominal adhesions,commonly known as postoperative intestinal adhesions,refers to abnormal adhesions between abdominal organs or between abdominal organs and the wall peritoneum caused by surgical injuries,which is the most common complication of abdominal surgery.Patients usually experience abdominal pain,abdominal distension,constipation,and in severe symptoms such as intestinal obstruction,intestinal necrosis,and female infertility,which seriously affect their quality of life and make it difficult to undergo another surgery.At present,postoperative abdominal adhesions are mainly prevented,and there is still no reliable diagnosis and treatment strategy for patients who experience adhesion-related symptoms after surgery.The current diagnosis still relies on surgical exploration as the gold standard,and can also be diagnosed based on clinical manifestations,combined with ultrasound,cine-MRI,and some laboratory tests.Gas abdominal CT three-dimensional simulation imaging of the peritoneal cavity is a promising diagnostic method.Although surgery is widely recognized as an effective treatment method,clinicians only choose surgical intervention when dealing with severe acute adhesive intestinal obstruction patients.Therefore,the current treatment mainly includes non-surgical treatment including traditional chinese medicine.This article reviews the progress in the diagnosis and treatment of postoperative abdominal adhesions in order to provide new ideas for clinical diagnosis and treatment.

关 键 词：手术后并发症 诊断 腹腔镜 治疗 腹腔粘连 

分 类 号：R656[医药卫生—外科学]