Clinical Regime's Study On Treatment Of Acute Intestinal Obstruction By Integration Of Combination Of TCM And Western Medicine With Laparoscopic Treatment

Objective: To creat a new regime, in which laparoscopic surgery is integrated into the combination of TCM and western medicine, in treatment of acute intestinal obstruction, as well as to explore the effect of the new program. Methods: From October 1997 to March 2003, 187 patients suffering from acute intestinal obstruction were treated in three stage. In the acute phase, the cases were initially conservative managed with combination of TCM and western medicine to resolve the obstruction. If the obstruction could not be released , the conversion to emergency laparoscopic operation was necessary. In the remission phase elective laparoscopic treatment was attempt to resolve the causes of the obstruction. Herb medicine was used in recovery phase,to prevent recurrent of adhesive small bowel obstruction. Results: In the acute phase, 17 cases underwent emergency surgery, and 170 were initially conservative treated with combination of TCM and western medicine. Conservative management was effective in 148 patients. 22 cases failed to convert to emergency operation. Emergency laparoscopic diagnostic operation was performed in 39 cases. The therapeutic operation was completed laparoscopically in 17 cases, while conversion to laparotomy proved necessary in 22 cases. The reason of conversion included: 7 intestinal infarction, 10 colon cancer, 5 intestinal perforation. After resolution of the obstruction, 107 patients should be managed with elective laparoscopic treatment in remission stage. 38 of them denied the operation. 69cases were approached laparoscopically. 63 were completed laparoscopically, and 6 patients, including: 1 ileal tumor, 3 intestinal perforation, 2 convoluted mass of adherent bowel, were converted to open surgery. The outcome of laparoscopic adhesiolysis was successful in 63 patients. All of them were randomly divided into two groups (the herd's group 33 cases and the control group 30 cases) in recovery phase. In each of the groups, there was 1 patient that recurred adhesive small bowel obstruction. In all the 187 cases, 4 patients died. Conclusion: The method of conservative management with combination of TCM and western medicine is effective in releasing the obstruction in acute stage. The causes of the intestinal obstruction can be successful resolved with laparoscopic treatment, thus to cure the disease. The laparoscopic surgery is one kind of minimally invasion operation, which create fewer intra-abdominal adhesion that leads to adhesive small bowel obstruction. The integration of the two approaches is a safe and effective treatment for acute intestinal obstruction.