结直肠癌术后早期炎性肠梗阻的诊断和治疗

Current status of diagnosis and treatment of early inflammatory bowel obstruction after colorectal cancer surgery

摘要:

术后早期炎性肠梗阻（EPISBO）是胃肠道手术后常见的并发症，结直肠癌术后EPISBO 的发病 率为4% ～ 15%。EPISBO 发病机制复杂，纤溶系统平衡破坏、神经反射、炎症反应及药物的相互作用可能是 其主要机制。EPISBO 的治疗应尽可能采用保守治疗，术前完善肠道准备，术中减少肠道损伤及肠内容物外溢， 减少腹腔污染的机会，术中适当应用防粘连剂，术后抑制炎症反应可预防EPISBO。

Abstract:

Academician, Jie-shou Li, put forward early postoperative inflammatory small bowel obstruction (EPISBO) for the first time on national gastrointestinal surgery conference in the 1995, and expounded the cause, characteristics, diagnosis and treatment of EPISBO. EPISBO is a common complication of colorectal cancer after operation, and certain literatures reported that the incidence of EPISBO after colorectal cancer surgery ranged from 4% to 15%. The pathogenesis of EPISBO is complex, and fibrinolytic system, neural reflex, inflammation, and drug interactions may be the pathogenesis of EPISBO. There is no consensus on diagnosis and management of EPISBO. EPISBO is different from other types of postoperative intestinal obstruction, and has its unique characteristics of diagnosis and treatment. EPISBO requires appropriate management with a proper diagnostic and therapeutic pathway. Indication and length of Non-operative treatment and appropriate timing for surgery may represent an insidious issue. Non -operative management should be attempted in absence of signs of peritonitis or strangulation; combining traditional with western medicine comprehensive treatment can obtain satisfactory curative effect. Improvement in the preoperative bowel preparation, intraoperative less trauma and intestinal contents to overflow, the opportunity to reduce the pollution of the abdominal cavity, anti-adhesion agent, postoperative inhibit inflammation can prevent EPISBO.