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目的:探讨急性粘连性肠梗阻病人的手术时机,以提高手术治疗效果。方法:回顾性分析我院1998～2008年手术治疗的61粘连性肠梗阻病例的临床资料,其中7例行腹腔镜粘连松解术。术中使用2～3支医用几丁糖凝胶以防止肠粘连。结果:本组手术治疗61例,非手术治疗95例。手术治疗患者中痊愈55例(88.2%),二次手术5例(10%),三次手术1例(2%)。术后肺部感染2例,切口感染3例,肠瘘2例,经保守治疗痊愈。1例死于感染性休克合并多器官功能衰竭综合征。结论:在非手术治疗前提下,粘连性肠梗阻病人手术时机宜把握在24～48 h。对粘连性肠梗阻病人应采取因人而异的个体化原则,重在密切观察病情的演变和有效的非手术治疗。术中应用医用几丁糖凝胶可以减少肠粘连,防止复发。
Objective: To investigate the timing of surgery in patients with acute adhesive intestinal obstruction to improve the effect of surgical treatment. Methods: The clinical data of 61 cases of adhesive intestinal obstruction treated by surgery in our hospital from 1998 to 2008 were retrospectively analyzed. Among them, 7 cases underwent laparoscopic adhesion lysis. Intraoperative use of 2 to 3 medical chitosan gel to prevent intestinal adhesion. Results: This group of 61 cases of surgical treatment, non-surgical treatment of 95 cases. Surgical treatment of patients recovered in 55 cases (88.2%), 5 cases of secondary surgery (10%), 3 cases of surgery in 1 case (2%). Postoperative pulmonary infection in 2 cases, incision infection in 3 cases, 2 cases of intestinal fistula, cured by conservative treatment. One patient died of septic shock complicated with multiple organ failure syndrome. Conclusion: Under the condition of non-surgical treatment, the timing of operation for patients with adhesive intestinal obstruction should be grasped in 24-48 h. Patients with adhesive intestinal obstruction should take individual principles of individual differences, focusing on close observation of the evolution of the disease and effective non-surgical treatment. Intraoperative application of medical chitosan gel can reduce intestinal adhesion, prevent recurrence.