肠梗阻死亡原因及手术时机问题

我室近20年手术治疗急性肠梗阻共437例,其中死亡40例(占9.19%),本文分析了40例中误诊的主要原因是过分强调腹部手术史,忽视了粘连性肠梗阻近半数合并肠扭转而致肠坏死,术前观察时间太长,多数超过72小时,丧失了手术机会。死亡原因除了13例合并腹腔脏器恶性肿瘤转移外,余均为肠穿孔致化脓性腹膜炎,中毒性休克及肠瘘等,结合40例死亡的教训,建议一旦有绞窄征象,应立即手术,文中提出了四种诊断绞窄的方法。

AN ANALYSIS OF DEATH CAUSE AND OPERATIVE TIME OF INTESTINAL OBSTRUCTION

Acute intestinal obstruction has been treated with surgery in 437 patients in the Laboratory of Abdominal Surgery of our hospital during the rast 20 years. Of these, 40(9.19%) died. This paper analyses the causes of misdiagnosis and death, showing that in over 50% cases, adhesive intestinal obstruction was accompanied by volvulus which often caused intestinal gangrene. Operative history of the abdomen was overemphasized. Preoperative observation lasted too long(over 72 hours), leading to the loss of the chance of operation. In 13 out of 40 dead cases, death was caused by malignant matastases, and in others by suppurative peritonitis due to intestinal perforation, toxic shock, intestinal fistula, etc. It is suggested that emergency surgery be performed as soon as the findings of strangulated intestinal obstruction are noticed. Four measures for diagnosing strangulated intestinal obstruction are discussed.