11 小肠疾病.ppt

Treatment Principles： Correct the systemic pathophysiologic disorder Relieve obstruction。 Basic Treatment Naso-gastric suction Correct body fluid disorder Prevent infection and intoxication General treatment:sedation,spasmolysis Remove the Obstruction Surgery Indications：strangulation、caused by tumor and congenital bowel malformation, can not relieved by medical therapy Aims：utility the simplest methods to remove the obstruction and recover the continuity of the bowel in the shortest time Methods Remove the cause ： Such as adhesion remove,foreign body taken out、replacement of intussusception and volvulus Intestinal resection and anastomosis: tumor,stenosis,necrosis How to judge the intestinal necrosis in the operation ? The bowel wall is black No peristaltic capability and tension No pulsation of mesenteric terminal arteriole Bypass operation: The lesion is difficult to remove Enterostomy or Intestinal exteriorization The patient’s condition cannot tolerance the complicated operation or the obstructive lesion is difficult to treat 手术方式 A.解除梗阻原因的术式 如粘连松解术 如肠切开取异物，肠扭转复位术。 B.肠切除肠吻合术 C.短路手术 D.肠造口和肠外置术 Medical treatment Indications： simple adhesive obstruction, paralysis or dynamic ileus、obstruction because of ascarid or stoolmass,inflammatory obstruction and early stage of intussusception Notes： The state of illness should be monitor closedly during medical treatment Common types Adhesive Obstruction（40%～60%） Obstruction due to adhesions Etiology and pathology Congenital Secondary Diagnosis Mechanical obstruction+ history of abdominal operation, infection or trauma *如何区分广泛粘连梗阻与局部束带梗 阻？？ Prophylaxis: more significance 减少组织损伤，减轻组织炎症反应 Treatment: simple, incomplete medical ther