Tamijmarane A, Chandra S, Smile S R
Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Trop Gastroenterol. 2000 Jul-Sep;21(3):141-3.
Mechanical intestinal obstruction remains one of the commonest surgical emergencies. With hernias being electively repaired and obstructive hernias becoming less common, adhesive obstruction has emerged as the leading cause of intestinal obstruction in the west. This study was designed to analyse any such changes in the pattern of intestinal obstruction in the population of Pondicherry of Tamilnadu of South India.
Data were collected from the compiled case records at JIPMER, Pondicherry, both retrospectively and prospectively from 1984 to 1992 about the clinical aspects of intestinal obstruction and analysed.
There were 572 patients admitted with a diagnosis of intestinal obstruction in this period. Obstructed external hernia occurred in 219 patients and adhesive obstruction in 176 patients. Fourteen percent of the patients with adhesive obstruction had appendicectomy as the index laparotomy in the past. Majority of the patients presented within 10 years of the index laparotomy. Adhesive obstruction was managed mainly by conservative treatment in 109 cases. There were 25 patients with recurrent obstruction; most of them were conservatively managed.
Obstructed external hernias were the commonest cause of intestinal obstruction. Increasing the patient awareness will help to decrease the incidence of obstructed hernias significantly. Adhesive obstruction deserves a conservative approach with judicious application of surgical intervention. A careful approach is required to avoid the increased morbidity and mortality associated with delay in the diagnosis of gangrenous obstructions.
机械性肠梗阻仍然是最常见的外科急症之一。随着择期疝修补手术的开展以及嵌顿性疝发病率的降低，粘连性肠梗阻已成为西方肠梗阻的主要原因。本研究旨在分析印度南部泰米尔纳德邦本地治里地区肠梗阻模式的变化。
回顾性和前瞻性收集1984年至1992年本地治里地区JIPMER医院汇编的病例记录中有关肠梗阻的临床资料并进行分析。
在此期间，有572例肠梗阻患者入院。其中219例为嵌顿性外疝，176例为粘连性肠梗阻。14%的粘连性肠梗阻患者既往有阑尾切除术作为首次剖腹手术史。大多数患者在首次剖腹手术后10年内发病。109例粘连性肠梗阻主要采用保守治疗。有25例患者反复发生肠梗阻，其中大多数采用保守治疗。
嵌顿性外疝是肠梗阻最常见的原因。提高患者意识将有助于显著降低嵌顿性疝的发病率。粘连性肠梗阻应采取保守治疗，并谨慎应用手术干预。需要谨慎处理，以避免因坏疽性肠梗阻诊断延迟而增加的发病率和死亡率。
