| Objective:Explore the factors of Obstetrics and Gynecology early postoperativeinflammatory ileus (EPISBO), clinical features and diagnosis and treatmentMethods: Dalian City Maternity Hospital and Dalian Central Hospital from2000to2012after gynecologic surgery concurrent EPISBO patients a total of26cases (33%)accounted for intestinal obstruction as research subjects, including16cases ofgynecological surgery, malignant tumors in9cases,7cases of benign tumors, mean age:43.78±27.34years old; obstetric surgery in10cases, average age32.12±2.9years old. EPISBO diagnostic criteria:①the near term (1-4weeks) history ofabdominal surgery (2) postoperative bowel movements once restored, but after eatingabdominal pain, abdominal distension, anal stop the exhaust defecation, there arevarying degrees of nausea and vomiting (3) abdominal distention, bloating generalsymmetric relatively mild abdominal pain, abdominal palpation a sense of flexibility, noobvious signs of peritonitis not touch the apparent intestinal trip or mass (4) abdominalX-ray film shows multiple fluid levels, intestine product fluid phenomenon, and can beseen in isolation, fixed a swollen bowel loops. Whole abdominal CT in the diagnosis ofearly postoperative inflammatory ileus has important reference value, you can displaythe intestinal wall edema, thickening, adhesion and intestine effusion product gas,intestinal uniform expansion and peritoneal exudate (5) rule out mechanical obstruction,paralytic ileus, and intestinal pseudo-obstruction. OUTCOME MEASURES:①concurrent EPISBO average age of patients, operative time (>3h) after gynecologicalsurgery, blood loss, intraoperative and postoperative transfusion of albumin (<30g), andhistory of previous surgery related factors and normal control group were compared;② after obstetric surgery concurrent EPISBO patients mean age, gravidity, parity,gestational age, fetal weight, postoperative analgesia, operative time (>1.8H), andpostpartum hemorrhage, intraoperative and postoperative transfusion of albumin (<30g)and a history of previous surgery related factors and the normal control group werecompared;(3) Gynaecology Obstetrics early postoperative inflammatory ileus patientswith postoperative twist general clinical status of patients with intestinal obstructioncontrol analysis. Statistical methods using the SPSS12.0information statistical analysis,count data using the chi-square test; measurement data using independent sample t test;First single factor logistic regression analysis, analysis of P <0.05screened variable intothe multivariate Logistic regression analysis for multivariate analysis. Various statisticalmethods in P <0.05as statistically significant.Results:1, gynecological study group: age, history of gastrointestinal disorders,operative time (>3hours), blood loss (≥800ml), intraoperative and postoperativewhether blood transfusion, albumin (<30g) and the recent history of abdominal surgerythere are differences in the comparison of the study group and the normal control group,the difference was statistically significant (P <0.05), suggesting that these factors andearly postoperative inflammatory ileus is affected, resulting in EPISBO factors;Although age, history of gastrointestinal disorders in the multivariate analysis, there aredifferences, but the single factor analysis shows its not the cause of EPISBO decisivefactor; obstetric study group: age, gravidity, parity, gestational age, birth weight, andpostoperative analgesia in the study group compared with the control group, thedifference was not statistically significant, suggesting that these factors has nothing todo with the early postoperative inflammatory ileus; However, operative time,intraoperative and post-natal blood loss, intraoperative and postoperative transfusion ofalbumin and previous surgery, there are significant differences in the comparativeanalysis of the study group and the control group, the difference was statisticallysignificant, suggesting that these factors are likely to be early postoperativeinflammatory relatively independent risk factor for intestinal obstruction, and confirmedin the univariate analysis, but operative time its not the cause of EPISBO decisive riskfactors in the univariate analysis;3, we select the obstetrics and gynecology surgeryafter concurrent strangulated intestinal obstruction in patients with a total of15cases asa disease control group and gynecology, obstetric study group general clinical statuswere compared, found the patients with EPISBO typical clinical features bowel function was restored, and then stop defecation exhaust obstruction phenomenon, physicalexamination abdominal pain; strangulated intestinal obstruction in patients withabdominal pain significantly, most of examination abdominal tenderness, weight alsoperitoneal irritation, and1patient had exhaust early inflammatory bowel34days afterconservative treatment of strangulation obstruction; study group of26patients, thepreferred conservative treatment:①the persistent gastrointestinal decompression (2)somatostatin application of nutritional support (3)(4) hormone application (5) ofantibiotics to cure the number of days for3-28days, an average of15.5days; cure ratewas96.1%(25/26); patients in the conservative treatment34days after the occurrenceof strangulation surgical treatment.Conclusion：One of the early postoperative inflammatory bowel is a post-operativecomplications has its own individual characteristics, the incidence rate is about20%ofthe postoperative intestinal obstruction.The treatment principles tend to conservativemedical treatment, and has formed a set of generally accepted principles of treatmentand programs.For EPISBO should focus on prevention, such as inevitable, should beearly diagnosis, reduce misdiagnosis and make timely treatment; standard conservativetreatment under the principle of early postoperative inflammatory ileus longcan not berelieved or recurrent, or strangulation or strangulation, surgery should be consideredpossible... |
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