Kokoska E R, Naunheim K S
Theodore Cooper Surgical Research Institute, St. Louis, Missouri, USA.
Chest Surg Clin N Am. 1998 Aug;8(3):645-61.
Postthoracotomy gastrointestinal complications, although relatively uncommon, can be associated with significant morbidity and mortality. It is necessary to identify patients who are at high risk for gastrointestinal complications during the preoperative evaluation. Appropriate stress ulcer prophylaxis should be provided to high-risk patients, and enteral feeds should be initiated as early in the postoperative course as possible. Postoperative hypotension and massive blood transfusions can be avoided with early reexploration in the case of postoperative hemorrhage. Finally, unexplained abdominal pain must not be ignored; a high index of suspicion should be maintained, with early and liberal use of diagnostic tools such as standard radiography, CT, endoscopy, and angiography. Consultation should be requested from a surgeon experienced in abdominal catastrophes. Early laparotomy with aggressive operative management can be lifesaving therapy but must be not applied in a cavalier fashion, as many of these disorders can and should be managed conservatively.
开胸术后胃肠道并发症虽然相对少见，但可能伴有严重的发病率和死亡率。在术前评估中识别出有胃肠道并发症高风险的患者很有必要。应给予高风险患者适当的应激性溃疡预防措施，并在术后尽早开始肠内喂养。对于术后出血，早期再次探查可避免术后低血压和大量输血。最后，不明原因的腹痛绝不能被忽视；应保持高度怀疑，尽早并广泛使用标准放射摄影、CT、内镜检查和血管造影等诊断工具。应向有腹部急症处理经验的外科医生咨询。早期剖腹手术及积极的手术处理可能是挽救生命的治疗方法，但绝不能随意应用，因为其中许多疾病可以且应该采用保守治疗。
