小结
定义
病史和体格检查
关键诊断因素
- 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）
其他诊断因素
- 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
危险因素
- 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）
诊断性检查
首要检查
- 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）
需考虑的检查
- 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
治疗流程
术后肠梗阻
非手术性病因
肠梗阻持续超过 3 天或延长术后恢复
撰稿人
作者
Steven D. Wexner, MD, PhD (Hon), FACS, FRCS (Eng), FRCS (Ed), FRCSI (Hon)
Director
Digestive Disease Center
Professor and Chair
Department of Colorectal Surgery
Cleveland Clinic
Weston
FL
利益声明
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
利益声明
SHER declares that he has no competing interests.
鸣谢
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.
利益声明
SPS, ASC, and PID declare that they have no competing interests.
同行评议者
David J. Hackam, MD, PhD
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
Pittsburgh
PA
利益声明
DJH declares that he has no competing interests.
John Jenkins, MB CHB, FRCP
Consultant Colorectal Surgeon
St. Mark's Hospital
Harrow
UK
利益声明
JJ declares that he has no competing interests.
鉴别诊断
- 机械性肠梗阻
- 假性梗阻（奥吉尔维氏综合征）
- 胃肠炎
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