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肠梗阻

最后审阅: 25 Jun 2024
最后更新: 11 Oct 2023

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)
完整详情

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
完整详情

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)
完整详情

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)
完整详情

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
完整详情

治疗流程

急症处理

术后肠梗阻

非手术性病因

持续性治疗

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)
Steven D. Wexner

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.

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