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肠梗阻

Last reviewed: 22 Sep 2024
Last updated: 11 Oct 2023

Summary

Definition

History and exam

Key diagnostic factors

  • 存在的危险因素
  • 恶心和呕吐
  • 腹胀
  • 无机械性梗阻或腹膜炎的特征(如腹疝、腹膜炎体征)
Full details

Other diagnostic factors

  • 顽固性便秘(不排便、不排气的严重便秘)
  • 不适与腹部绞痛
  • 肠鸣音减少或减弱
  • 低血容量
Full details

Risk factors

  • 腹部手术
  • 急性/系统性疾病(例如心肌梗死、肺炎、急性胆囊炎、胰腺炎、脓毒症和多器官外伤)
  • 非腹部手术
  • 电解质失调
  • 阿片类镇痛药、抗胆碱能类药物或麻醉气体
  • 并存症(如糖尿病、心血管功能不全、查格斯病、硬皮病)
Full details

Diagnostic tests

1st tests to order

  • 血清电解质
  • 血清镁
  • 全血细胞计数 (FBC)
  • 腹部和盆腔 CT 扫描(使用静脉注射造影剂和口服型水溶性造影剂)
Full details

Tests to consider

  • 血清肝功能检查
  • 血清淀粉酶
  • 血清脂肪酶
  • 小肠钡餐检查
  • 胃排空检查
Full details

Treatment algorithm

ACUTE

术后肠梗阻

非手术性病因

ONGOING

肠梗阻持续超过 3 天或延长术后恢复

Contributors

Authors

Steven D. Wexner, MD, PhD (Hon), FACS, FRCS (Eng), FRCS (Ed), FRCSI (Hon)
Steven D. Wexner

Director

Digestive Disease Center

Professor and Chair

Department of Colorectal Surgery

Cleveland Clinic

Weston

FL

Disclosures

SDW has received consulting fees, stock options, and royalties from the following companies. These relationships are ongoing. Consulting: ICON Language Services, Intuitive Surgical, Stryker, Medtronic, Takeda, ARC/Corvus, Astellas, Baxter, Olympus, AIS Channel, Livsmed. Royalties: Medtronic, Intuitive Surgical, Karl Storz Endoscopy-America, Unique Surgical Innovations. Stock Options: Regentys, LifeBond, Pragma/GibLib, and Renew Medical.

Sameh Hany Emile Rizkalla, MBBCh, MSc, MD, FACS

Research associate, Colorectal Surgery Department

Digestive Disease Center

Professor and Chair

Department of Colorectal Surgery

Cleveland Clinic

Weston

FL

Disclosures

SHER declares that he has no competing interests.

Acknowledgements

Dr Steven D. Wexner would like to gratefully acknowledge the contribution of Dr Stephen P. Sharp to the update for this topic. Dr Wexner would also like to acknowledge Dr Ahmed Sami Chadi, and Dr Paula I. Denoya, previous contributors to this topic.

Disclosures

SPS, ASC, and PID declare that they have no competing interests.

Peer reviewers

David J. Hackam, MD, PhD

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

Divulgaciones

DJH declares that he has no competing interests.

John Jenkins, MB CHB, FRCP

Consultant Colorectal Surgeon

St. Mark's Hospital

Harrow

UK

Divulgaciones

JJ declares that he has no competing interests.

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