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粘连性肠梗阻,传统观念是以保守疗法为主,近年来,我院收治4例粘连性肠梗阻分别采用保守治疗和积极手术治疗,其效果截然不同,现报告如下:1 病例报告例1:患者男,58岁,腹痛、腹胀、呕吐、肛门停止排气排便24小时,1997年9月20日人院.8年前施行胃大部切除术.查体:生命体征正常,腹部稍膨隆,无腹膜刺激现象,肠鸣音亢进,X线腹部平片示左上腹部有液平面.诊断粘连性肠梗阻,先保守治疗.入院后第4天,腹胀加重,尿量少,脉搏120次/分,腹部有触痛及反跳痛,腹部再摄X线片示气液平面增多,当晚在全麻下行剖腹探查,术中诊断粘连性内疝,嵌入肠管旋转约360度,胆管及其系膜充血、水肿,呈紫红色,切断并旷置疝入肠管近端行端侧吻合术,术后第2天发生肠破裂并中毒性休克,再次手术,见旷置粘连甚紧,嵌入肠管已坏死,侧壁穿破,腹腔内有大量肠内容物,病家放弃治疗,接回家死亡.
Adhesive intestinal obstruction, the traditional concept is based on conservative treatment, in recent years, our hospital treated 4 cases of adhesive intestinal obstruction were conservative treatment and active surgical treatment, the effect is very different, are as follows: 1 Case Report 1: Patients male, 58 years old, abdominal pain, abdominal distension, vomiting, anal defecation exhaust 24 hours, September 1997, hospital 0. 8 years ago the implementation of subtotal gastrectomy Physical examination: normal vital signs, abdominal slightly bulging, No peritoneal irritation, bowel sounds hyperthyroidism, X-ray abdominal plain film showed a left upper abdomen with fluid level. Diagnosis of adhesive intestinal obstruction, the first conservative treatment .4 days after admission, abdominal distension, decreased urine output, pulse 120 beats / min , Abdomen tenderness and rebound tenderness, abdomen X-ray film showed an increase in rectum, night under general anesthesia laparotomy exploration, intraoperative diagnosis of adhesive hernia, embedded in the intestine rotated about 360 degrees, the bile duct and its mesangium Congestion, edema, was purple, cut off and exclusion of hernia into the proximal end of the bowel end of line anastomosis, intestinal rupture and toxic shock occurred after 2 days, reoperation, see exclusion adhesions very tight, embedded intestine has been necrosis , Perforation of the side wall, abdominal a large number of intestinal contents, patients give up treatment, take home death.