Bass K N, Jones B, Bulkley G B
Duke University Medical Center, Durham, North Carolina, USA.
Adv Surg. 1997;31:1-34.
In conclusion, most of the recent advances in the management of small bowel obstruction consist of developments in the imaging modalities available to assist in the diagnosis itself, particularly with regard to the distinction between partial and complete obstruction. Unfortunately, little progress has been made to enable physicians to detect early, reversible strangulation, and therefore the surgical management of small-bowel obstruction has changed very little over the past 10 years. Because of the inability to detect reversible ischemia, there is a substantial risk of progression to irreversible ischemia (and an inherent rise in morbidity and mortality) when surgery is delayed for an extended period of time, especially in the setting of suspected complete obstruction. However, almost all patients do benefit from an initial 12 to 24 hours of resuscitation and decompression in cases of complete obstruction; resuscitation and decompression can usually be extended for a longer period of time in those patients with partial obstruction who exhibit no signs of progression (Fig 6). It is encouraging, however, that some advances have been made in understanding the pathophysiology and prevention of adhesion formation. Research efforts in the future should continue to focus on these issues as well as on the development of methods to better recognize early signs of strangulation.
总之，小肠梗阻管理方面的近期进展大多在于可用于辅助诊断本身的成像方式的发展，特别是在区分部分性和完全性梗阻方面。不幸的是，在使医生能够早期检测可逆性绞窄方面进展甚微，因此在过去10年中小肠梗阻的外科治疗变化很小。由于无法检测到可逆性缺血，当手术延迟较长时间时，尤其是在疑似完全性梗阻的情况下，进展为不可逆缺血（以及发病率和死亡率必然上升）的风险很大。然而，几乎所有完全性梗阻患者在最初12至24小时的复苏和减压中都会受益；对于那些没有进展迹象的部分性梗阻患者，复苏和减压通常可以延长更长时间（图6）。不过，令人鼓舞的是，在理解粘连形成的病理生理学和预防方面已经取得了一些进展。未来的研究工作应继续关注这些问题以及更好识别绞窄早期迹象方法的开发。
