Livingston E H, Passaro E P
Surgical Service, West Los Angeles Veterans Administration Medical Center 90073.
Dig Dis Sci. 1990 Jan;35(1):121-32. doi: 10.1007/BF01537233.
Postoperative ileus follows any operation. Although worsened if the peritoneum is entered, the length and duration of surgery does not influence the severity of postoperative ileus. Inhibitory alpha 2-adrenergic reflexes with peptidergic afferents contribute to postoperative ileus. Clinically, treatment of ileus centers around symptomatic relief with nasogastric suction. Trials of adrenergic blockade combined with cholinergic stimulation have met with limited success. Prokinetic drugs have not been proved effective in the treatment of this disorder. Two types of ileus exist: postoperative and paralytic. Postoperative ileus resolves spontaneously after two to three days, and probably reflects inhibition of colonic motility. Paralytic ileus is more severe, last more than three days, and seems to represent inhibition of small bowel activity. No discrete structural changes cause postoperative ileus and the role of peptidergic neuronal systems of the enteric nervous system has not been elucidated. Possible central or humoral mechanisms have not been studied extensively. The possible direct inhibition of enteric or spinal nerves by anesthetic agents not cleared from these tissues remains to be studied. Also in need of study is the potential alteration of neurotransmitter receptor activity within the enteric nervous plexus after manipulation of the bowel.
术后肠梗阻在任何手术后都会发生。尽管如果进入腹膜会加重，但手术的时长和持续时间并不影响术后肠梗阻的严重程度。具有肽能传入神经的抑制性α2 - 肾上腺素能反射会导致术后肠梗阻。临床上，肠梗阻的治疗主要围绕通过鼻胃管吸引进行症状缓解。肾上腺素能阻断联合胆碱能刺激的试验取得的成功有限。促动力药物尚未被证明对治疗这种疾病有效。存在两种类型的肠梗阻：术后肠梗阻和麻痹性肠梗阻。术后肠梗阻在两到三天后会自行缓解，这可能反映了结肠动力的抑制。麻痹性肠梗阻更严重，持续时间超过三天，似乎代表小肠活动受到抑制。没有离散的结构变化会导致术后肠梗阻，并且肠神经系统中肽能神经元系统的作用尚未阐明。可能的中枢或体液机制尚未得到广泛研究。麻醉剂未从这些组织中清除而对肠或脊神经可能产生的直接抑制作用仍有待研究。肠道操作后肠神经丛内神经递质受体活性的潜在改变也需要研究。
