CAJ | 학술논문

目的研究术后早期小肠内疝的临床特点. 方法回顾性研究1994-2006年38例腹部手术后早期小肠梗阻(early postoperative small bowel obstruction,EPSBO)患者的临床资料.结果手术治疗术后早期小肠梗阻(发生于术后30 d内)的38例中各种原因所致小肠内疝占9例(23.7%).男6例,女3例,平均年龄53.6岁(32～72岁).术后出现症状的平均时间为7.8 d(2～17 d),平均行保守治疗时间为3.4 d(1～8 d).术后早期内疝的主要临床表现为:完全性机械性梗阻表现,症状重,进展快,可早期出现肠绞窄.影像学检查可能发现特征性内疝表现,以增强CT检查最佳.本组术中见6例患者已发生肠绞窄,其中4例患者发生肠坏死.本组共行肠切除术5例.术后平均住院时间为15.8 d(8～42 d).1例患者术后发生切口感染,无围术期死亡患者.结论小肠内疝可发生于术后早期,易于发生绞窄坏死,应积极外科手术治疗,可获得理想的效果.
목적 연구술후조기소장내산적림상특점. 방법회고성연구1994-2006년38례복부수술후조기소장경조(early postoperative small bowel obstruction,EPSBO)환자적림상자료.결과 수술치료술후조기소장경조(발생우술후30 d내)적38례중각충원인소치소장내산점9례(23.7%).남6례,녀3례,평균년령53.6세(32～72세).술후출현증상적평균시간위7.8 d(2～17 d),평균행보수치료시간위3.4 d(1～8 d).술후조기내산적주요림상표현위:완전성궤계성경조표현,증상중,진전쾌,가조기출현장교착.영상학검사가능발현특정성내산표현,이증강CT검사최가.본조술중견6례환자이발생장교착,기중4례환자발생장배사.본조공행장절제술5례.술후평균주원시간위15.8 d(8～42 d).1례환자술후발생절구감염,무위술기사망환자.결론 소장내산가발생우술후조기,역우발생교착배사,응적겁외과수술치료,가획득이상적효과.
Objective To investigate the clinical manifestations of early postoperative internal hernia. Methods Patients who were diagnosed with early postoperative small bowel obstruction(EPSBO)within 30 days after operation and underwent laparotomy between 1994 and 2006 were included for study.Clinical and radiological findings were analyzed. Results Totally 38 EPSBO patients were identined.among those,9 patients(23.7%)had an internal hera ag the cause of the howel obstruction.Other causes included intestinal adhesions in 27 patients(71.1%),gallstone ileus in 1 patient(2.6%)and stoma obstruction in 1 patient(2.6%).In the internal hernia group,6 cases were male and 3 cases were female witIl a mean age of 53.6 years.The mean time from the primary operation to symptom development was 7.8 d(range,2～17 d)and the mean time of conservative treatment Was 3.4 d(range,1～8 d).The main clinical features included:complete mechanical obstruction with symptoms rapidly progressing and early bowel strangulation.Specific radiologic abnormalities misht be identified,especially by contrast-enhanced CT.In this series,intestinal strangulation was found in 6 patients with bowel necrosis in 4 eases,necessitating howel resection in 5 patients.Wound infection developed in one cage and there was no perioperative death.Conclusion Internal hernia can occur early postoperatively and it bears a high risk of strangulation and bowel necrosis.Prompt operative intervention should be carried out in highly suspicious patients in order to avoid complications and achieve good outcome.