对粘连包裹的腹部进行再次手术。

Reoperation on the abdomen encased in adhesions.

作者信息

Harris Eric A, Kelly Ann W, Pockaj Barbara A, Heppell Jacques, Hentz Joseph G, Kelly Keith A

机构信息

Department of Surgery, Mayo Clinic Scottsdale, 13400 East Shea Blvd., Scottsdale, AZ 85255, USA.

出版信息

Am J Surg. 2002 Dec;184(6):499-504; discussion 504. doi: 10.1016/s0002-9610(02)01067-x.

DOI:10.1016/s0002-9610(02)01067-x

PMID:12488146

Abstract

PURPOSE

To determine outcome after lysis of intestinal adhesions, relief of obstruction, closure of fistulas and drainage of abscesses in patients with an abdominal cavity obliterated by chronic postoperative adhesions.

METHODS

Among 40 patients with an abdomen encased in dense adhesions after a mean of 5 previous operations, 31 patients also had intestinal obstruction, 25 enteric fistulas and 20 abdominal abscesses. Reoperation was done and outcome assessed from the medical records and by a mailed questionnaire.

RESULTS

Only 1 postoperative death occurred, but 24 early complications appeared. At hospital discharge, obstruction, fistula and abscess were completely resolved in all but 3 patients (P <0.001). Only 2 of 16 patients on parenteral nutrition before operation (TPN) still required it (P = 0.004). At late follow-up (mean, 4.6 years) the patients' quality of life (mean score +/- SD, 8.6 +/- 2.1) was similar to that of a healthy control population (9.2 +/- 1.2, P = 0.17).

CONCLUSIONS

Reoperation on the abdomen encased in adhesions restores most patients to good health and an excellent long-term quality of life.

摘要

目的

确定在因慢性术后粘连导致腹腔闭塞的患者中，进行肠粘连松解、梗阻解除、瘘管闭合及脓肿引流后的结果。

方法

在40例平均曾接受过5次手术且腹部被致密粘连包裹的患者中，31例同时存在肠梗阻，25例有肠瘘，20例有腹部脓肿。进行了再次手术，并根据病历和邮寄的问卷对结果进行评估。

结果

仅发生1例术后死亡，但出现了24例早期并发症。出院时，除3例患者外，所有患者的梗阻、瘘管和脓肿均完全缓解（P<0.001）。术前接受肠外营养（TPN）的16例患者中，仅2例仍需要（P = 0.004）。在晚期随访（平均4.6年）时，患者的生活质量（平均得分±标准差，8.6±2.1）与健康对照人群相似（9.2±1.2，P = 0.17）。