Alvarez R D
Department of Obstetrics and Gynecology, University of Alabama, Birmingham.
Obstet Gynecol. 1988 Sep;72(3 Pt 2):533-40.
A working familiarity with the management of common perioperative gastrointestinal complications is required for all general gynecologists. Thermal gastrointestinal injury requires resection of the damaged portion of bowel unless the injury involves only the bowel serosa and is less than 0.5 cm in diameter. Small intraoperative lacerations of the intestine can be closed primarily, whereas larger lacerations often require resection. Some degree of postoperative ileus may be expected, but prolonged ileus requires nasogastric suctioning while excluding bowel obstruction, peritonitis, or electrolyte imbalance. Small-bowel obstruction, most likely to be caused by postoperative adhesions, can often be treated successfully by gastrointestinal intubation. Steps required in the initial management of an enterocutaneous fistula include institution of parenteral nutritional supplementation and antibiotics, skin protection, and investigative studies of the fistula. Preventive measures may be used at the time of any surgical procedure to reduce the incidence of many of these complications.
所有普通妇科医生都需要对常见围手术期胃肠道并发症的处理有实际的了解。热损伤导致的胃肠道损伤需要切除受损的肠段，除非损伤仅累及肠浆膜且直径小于0.5厘米。术中较小的肠撕裂伤可直接缝合，而较大的撕裂伤通常需要切除。术后可能会出现一定程度的肠梗阻，但持续性肠梗阻需要进行鼻胃管抽吸，同时排除肠梗阻、腹膜炎或电解质失衡。小肠梗阻最常见的原因是术后粘连，通常可通过胃肠插管成功治疗。肠皮肤瘘初始处理所需的步骤包括给予肠外营养补充和抗生素、保护皮肤以及对瘘管进行检查。在任何手术过程中都可采取预防措施以降低许多此类并发症的发生率。
