中国基层医药
中國基層醫藥
중국기층의약
CHINESE JOURNAL OF PRIMARY MEDICINE AND PHARMACY
2014年
10期
1479-1480,1481
,共3页
曹双军%石庆龙%王红禄%任正华%赵雪松%方磊
曹雙軍%石慶龍%王紅祿%任正華%趙雪鬆%方磊
조쌍군%석경룡%왕홍록%임정화%조설송%방뢰
疝,腹部%肠梗阻%诊断%治疗学
疝,腹部%腸梗阻%診斷%治療學
산,복부%장경조%진단%치료학
Hernia,abdominal%Intestinal obstruction%Diagnosis%Therapeutics
目的:通过对无腹部手术史的腹内疝致肠梗阻病例的诊治分析,提高对腹内疝致肠梗阻的认识。方法对23例无腹部手术史的腹内疝所致肠梗阻患者临床资料进行回顾分析。分析腹内疝致肠梗阻的临床表现、类型及发病因素,并对其诊治及预防进行讨论。结果全组患者由肠血液循环障碍引起,其中小肠肠系膜裂孔疝11例,十二指肠旁疝2例,盲肠旁疝2例,大网膜裂孔疝3例,闭孔疝1例,先天性肠管发育不良和扭转致小肠系膜疝2例,腹腔内单纯束带形成压迫肠管2例。患者中8例出现肠坏死。22例经手术治疗后痊愈,1例死亡,12例患者术后出现并发症。出现肠坏死患者术后并发症发病率为59.3%(切口感染37.1%,肺炎22.2%),明显高于无肠坏死组的11.8%(切口感染5.9%、肺炎5.9%)(χ2=3.861、3.861,均P<0.05)。结论无腹部手术史的腹内疝致肠梗阻为闭襻性肠梗阻,术前诊断困难,病情发展迅速,不及时手术治疗短期内可出现肠绞窄、肠坏死。故早期诊断、及时手术治疗是诊治无腹部手术史的腹内疝致肠梗阻的关键。
目的:通過對無腹部手術史的腹內疝緻腸梗阻病例的診治分析,提高對腹內疝緻腸梗阻的認識。方法對23例無腹部手術史的腹內疝所緻腸梗阻患者臨床資料進行迴顧分析。分析腹內疝緻腸梗阻的臨床錶現、類型及髮病因素,併對其診治及預防進行討論。結果全組患者由腸血液循環障礙引起,其中小腸腸繫膜裂孔疝11例,十二指腸徬疝2例,盲腸徬疝2例,大網膜裂孔疝3例,閉孔疝1例,先天性腸管髮育不良和扭轉緻小腸繫膜疝2例,腹腔內單純束帶形成壓迫腸管2例。患者中8例齣現腸壞死。22例經手術治療後痊愈,1例死亡,12例患者術後齣現併髮癥。齣現腸壞死患者術後併髮癥髮病率為59.3%(切口感染37.1%,肺炎22.2%),明顯高于無腸壞死組的11.8%(切口感染5.9%、肺炎5.9%)(χ2=3.861、3.861,均P<0.05)。結論無腹部手術史的腹內疝緻腸梗阻為閉襻性腸梗阻,術前診斷睏難,病情髮展迅速,不及時手術治療短期內可齣現腸絞窄、腸壞死。故早期診斷、及時手術治療是診治無腹部手術史的腹內疝緻腸梗阻的關鍵。
목적:통과대무복부수술사적복내산치장경조병례적진치분석,제고대복내산치장경조적인식。방법대23례무복부수술사적복내산소치장경조환자림상자료진행회고분석。분석복내산치장경조적림상표현、류형급발병인소,병대기진치급예방진행토론。결과전조환자유장혈액순배장애인기,기중소장장계막렬공산11례,십이지장방산2례,맹장방산2례,대망막렬공산3례,폐공산1례,선천성장관발육불량화뉴전치소장계막산2례,복강내단순속대형성압박장관2례。환자중8례출현장배사。22례경수술치료후전유,1례사망,12례환자술후출현병발증。출현장배사환자술후병발증발병솔위59.3%(절구감염37.1%,폐염22.2%),명현고우무장배사조적11.8%(절구감염5.9%、폐염5.9%)(χ2=3.861、3.861,균P<0.05)。결론무복부수술사적복내산치장경조위폐반성장경조,술전진단곤난,병정발전신속,불급시수술치료단기내가출현장교착、장배사。고조기진단、급시수술치료시진치무복부수술사적복내산치장경조적관건。
Objective To analyze the diagnosis and treatment of intestinal obstruction patients caused by intra-abdominal hernia with no abdominal surgery history ,in order to raise awareness .Methods Clinical data of 23 intestinal obstruction patients caused by intra-abdominal hernia with no abdominal surgery history were retrospectively analyzed.The clinical manifestations ,type,and risk factors were analyzed .And its diagnosis and prevention was dis-cussed.Results 23 patients were caused by intestinal blood circulation disorders ,in which there were 11 cases small intestine mesentery hernia ,2 cases duodenal hernia ,2 cases pericecal hernia ,3 cases omentum hernia ,1 case obturator hernia,2 cases congenital dysplasia and intestinal mesenteric torsion induced small hernia ,2 cases formation of intra-abdominal pressure alone belted intestine ,8 cases of intestinal necrosis .22 patients were cured after surgery ,1 case died,12 cases had postoperative complications .The incidence rate of postoperative complications of patients with in-testinal necrosis was 59.3%( wound infection 37.1%, pneumonia 22.2%), which was significantly higher than 11.8%of patients without intestinal necrosis (wound infection 5.9%,pneumonia 5.9%)(χ2 =3.861,3.861,all P<0.05).Conclusion The intestinal obstruction caused by intra-abdominal hernia with no abdominal surgery history is closed loop obstruction , preoperative diagnosis is difficult , with the rapid progression of the disease , and intestinal strangulation ,intestinal necrosis can occur in the short term whithout timely surgical treatment .Therefore ,early diagno-sis and prompt surgical treatment is the key to the diagnosis and treatment of intestinal obstruction caused by intra -ab-dominal hernia with no abdominal surgery history .