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急性肠梗阻是最常见的外科急腹症之一,晚期肝硬化常有多系统受累,合并急性肠梗阻已非少见。现将本院1995年11月～1997年7月收治的12例报道如下。 一、临床资料 (一)一般资料 12例均为住院患者,男性9例,女性3例,年龄23～62岁,肝病史2周～11年,其中10例已发展为慢性重型肝炎。12例均有腹水,同期合并原发性腹膜炎11例,出血4例,电解质紊乱10例,肝性脑病9例,肝肾综合征2例。3例有腹部手术史(2例为数年前阑尾、尿路结石手术,1例为发生肠梗阻前32天行脐疝修补术)。 (二)临床表现 首发症状分别为腹痛4例、明显腹胀8例,其中3例伴呕吐,7例7～24小时内无排便排气,9例发热(体温37.3～39.7℃),无寒战。体征主要为腹部胀满,6例腹部有不同程度压痛,4例有反跳痛,12例均未见肠型、蠕动波,未触及包块,肠鸣音均活跃或亢进,10例可闻气过水声。 (三)辅助检查 急诊腹部X线摄片7例、透视5例,均示肠腔胀气明显,可见数个液平面而诊断为肠梗阻。发生肠梗阻后,血胆红素增高幅度>51μmol/L 7例,凝血酶原活动度下降9例,其中8例降至25％以下。4例血钾<3.5mmol/L,8例血钠<135mmol/L。
Acute intestinal obstruction is one of the most common surgical acute abdomen, advanced liver cirrhosis often multiple system involvement, with acute intestinal obstruction has been rare. Now this hospital from November 1995 to July 1997 admitted 12 cases are reported as follows. First, the clinical data (A) General Information 12 patients were hospitalized patients, 9 males and 3 females, aged 23 to 62 years old, liver disease history of 2 weeks to 11 years, of which 10 cases have developed into chronic severe hepatitis. All 12 cases had ascites. In the same period, 11 cases had primary peritonitis, 4 cases had hemorrhage, 10 cases had electrolyte disturbance, 9 cases had hepatic encephalopathy and 2 cases had hepatorenal syndrome. Three cases had a history of abdominal surgery (two cases of appendectomy and urolithiasis a few years ago, and one case of umbilical hernia repair 32 days before the occurrence of intestinal obstruction). (B) Clinical manifestations The first symptom was abdominal pain in 4 cases, significant abdominal distension in 8 cases, 3 cases with vomiting, 7 cases 7 to 24 hours without defecation exhaust, 9 cases of fever (body temperature 37.3 ~ 39.7 ℃), no chills. Signs were mainly abdominal fullness, 6 cases of abdominal tenderness with varying degrees, 4 cases of rebound tenderness, 12 cases were no intestinal type, peristaltic wave, without mass, bowel sounds were active or hyperthyroidism, 10 cases can be heard Gas over the water sound. (C) of the auxiliary examination of emergency abdominal radiography in 7 cases, 5 cases of fluoroscopy, showed flatulence flatulence, showing a number of fluid level diagnosis of intestinal obstruction. Intestinal obstruction occurred after the increase in serum bilirubin> 51μmol / L in 7 cases, decreased prothrombin activity in 9 cases, of which 8 cases fell below 25%. 4 cases of serum potassium <3.5mmol / L, 8 cases of serum sodium <135mmol / L.