Can intestinal obstruction be cured?

Question 1: Intestinal obstruction cannot be operated. Is there a good method of conservative treatment? The treatment of medical (1) intestinal obstruction lies in relieving obstruction and restoring intestinal patency. It is worth noting that the threat to patients' lives is not entirely due to intestinal obstruction itself, but the systemic pathophysiological changes caused by intestinal obstruction. In order to save the patient's life, we should correct the disorder of water and electrolyte in time and reduce the expansion of intestinal cavity. Surgical treatment should be carried out after the pathological and physiological changes of the whole body are corrected. 1. Once the diagnosis of gastrointestinal decompression is confirmed, gastrointestinal decompression should be performed immediately to reduce abdominal distension. It can also prevent elderly patients from aspiration. Leaving the gastric tube in the stomach can suck out the liquid and gas that the intestinal tube returns to the stomach, reduce the degree of intestinal tube expansion, and is beneficial to surgical exploration. For simple adhesive intestinal obstruction, only gastrointestinal decompression and intravenous infusion can sometimes relieve the obstruction and avoid reoperation. X-ray examination was repeated after gastrointestinal decompression for 65438 0.2 hours. If the inflation of the small intestine is reduced, the intestinal obstruction will be relieved when the colon is inflated. 2. Water and electrolyte supplement According to the location of intestinal obstruction, the length of obstruction and the results of laboratory examination, water and electrolyte should be supplemented. Because the fluid lost in vomiting and gastrointestinal decompression is similar to extracellular fluid, the supplementary fluid is mainly isotonic fluid. For patients with severe dehydration, it is particularly important to replenish blood volume before operation, otherwise blood pressure may drop under anesthesia. In strangulated intestinal obstruction, it is particularly important to supplement plasma and whole blood in addition to isotonic fluid, especially when blood pressure and pulse rate have changed. 3. Application of antibiotics Simple intestinal obstruction does not require antibiotics. For strangulated intestinal obstruction, the method of reducing bacterial reproduction should be adopted, especially when peritonitis is caused by intestinal necrosis. 4. In addition to the above treatment methods, the following measures can be added for non-surgical treatment: the oil can be taken orally in batches or injected through gastrointestinal decompression tube with paraffin oil, raw soybean oil or vegetable oil of 200 ~ 300 ml. It is suitable for people with serious illness and weak constitution. Paralytic intestinal obstruction can be treated with neostigmine injection and abdominal mirabilite hot compress if there is no operation. Acupuncture at Zusanli, Zhongyu, Shu Tian, Neiguan, Hegu and Neiting can be used as adjuvant therapy. 5. Surgical treatment After the above treatment, some patients can be relieved. If abdominal pain is aggravated, vomiting persists, white blood cells are elevated, and body temperature is also elevated, surgery must be performed. The observation time should not exceed 48h to avoid intestinal strangulation and necrosis. According to the different causes of obstruction, the surgical methods are also different. Generally, there are four methods: (1) adhesion release and reduction: exploratory laparotomy without blood leakage is mostly simple obstruction. If the intestinal dilatation is not serious, trace the junction of intestinal collapse and dilatation from top to bottom, that is, the location of obstructive lesions. Adhesion release, volvulus and intussusception reduction can be performed according to the etiology. If the intestine expands obviously above the obstruction, the expanded intestine should be decompressed first to avoid rupture due to traction during exploration. (2) Short-circuit anastomosis between intestinal loops: If the causes of obstruction, such as cancer, radiation enteritis and abdominal tuberculosis, cannot be removed, the adhesion is very serious and it is difficult to separate. Forced separation often causes intestinal rupture, resulting in postoperative intestinal fistula, and short-circuit anastomosis can be performed between the upper and lower intestinal segments at the obstruction site. Generally, there are two types of anastomosis: ① Side-to-side anastomosis: Side-to-side anastomosis is performed between intestinal loops above and below the obstruction. This kind of anastomosis will form a blind loop between the anastomosis and obstruction, which may lead to blind loop syndrome in the future, and sometimes ulcers will cause intestinal bleeding. ② End-to-side anastomosis: cut off proximal intestinal obstruction and distal intestinal obstruction, and perform end-to-side anastomosis. (3) Enterostomy: generally suitable for colon obstruction, such as sigmoid colon cancer complicated with obstruction. Abdominal distension above obstruction has severe edema and intestinal infection, and one-stage surgical resection and anastomosis often leads to anastomotic leakage. Therefore, for colonic obstruction, colostomy is often performed above the obstruction first. Small intestinal obstruction, especially high obstruction, is not suitable for colostomy, otherwise it will cause serious fluid loss and skin erosion of abdominal wall, and the nutrition of patients who have done colostomy for a long time is difficult to maintain. (4) Intestinal resection and anastomosis: One-stage resection and anastomosis should be performed for intestinal wall necrosis caused by obstruction. For intestinal volvulus and intestinal obstruction caused by mesenteric vascular embolism, necrotic bowel resection should be performed, and end-to-end anastomosis is ideal. Shock patients are in critical condition and should not continue the operation time, but resection of necrotic intestine is equivalent to resection of the lesion, and sometimes blood pressure can be restored. We should be as careful as possible during the operation. Generally, the torn serosa surface should be sutured with thin thread, or covered with adjacent serosa surface of small intestine to avoid rough surface exposure and adhesion in the future. Before suturing the peritoneum, arrange the small intestine properly, hoping to form a neat arrangement between the mesenteries. & gt

Question 2: Can adhesive intestinal obstruction be cured? Adhesive intestinal obstruction is mostly simple intestinal obstruction, which can be treated by non-surgery first. The pathological changes of intestinal adhesion existed long before the occurrence of obstruction, and the passage of intestinal contents was blocked only after intestinal motility disorder or satiety. With the retention of intestinal contents, intestinal wall edema and intestinal dilatation further aggravate the obstruction. Obstruction can often be relieved if the proximal intestinal cavity of obstruction can be effectively decompressed. The key problem is how to effectively decompress the obstruction. Recently, we tied a small piece of silk at the end of M-A tube, and sent the end of the tube to the front of pylorus to adjust the patient. If the tube end still fails to pass through the pylorus after 12 hours, we use biopsy forceps or foreign body forceps to clamp the thread of the tube end under the direct vision of gastroscope, send the balloon partially through the pylorus, then inflate the balloon and gradually send the tube inward. The tube end can reach the obstruction and be sucked out within 12 hours. At this time, injecting paraffin oil 150 ~ 200 ml can often work. Two consecutive patients with adhesive intestinal obstruction were ineffective after decompression through gastric tube for 5 ~ 7 days, and all of them were successfully cured by inserting M-A tube as described above (Figure 26- 1 ~ 3). If non-surgical treatment is ineffective, surgical treatment should be performed. After a short preparation, strangulated intestinal obstruction should be operated as soon as possible. The purpose of surgical treatment is to relieve obstruction and prevent recurrence. The adhesion can be separated with a sharp knife or the umbilical cord can be removed to relieve the obstruction, and the rough surface can be turned over and stitched to reduce the chance of re-adhesion. If the adhesion of intestinal curvature is difficult to separate, and less intestinal segments are involved, the adhesion can be removed and anastomosed again. If the adhesion range is extremely wide, additional operation is needed to fix the small intestine in order to prevent adhesion and obstruction after adhesion separation. Now briefly introduce various arrangement operations. , 1, aristocratic folding was initiated by aristocrats on 1937. After all the intestinal adhesions were separated, the small intestine was folded into parallel intestinal segments according to the width of abdominal cavity, and the mesenteric walls of adjacent intestinal segments were sutured with 3-0 chrome catgut, leaving 3cm at both ends without suture to prevent the formation of acute angles. If only part of the small intestine is folded, the mesenteric edges at both ends should also be sutured to avoid intra-abdominal hernia. Noble operation takes a long time, and the recovery of intestinal function after operation is slow, which takes about 8 ~ 12 days. It is rarely used now. 2. Children's Surgery 1960 Children summarized three shortcomings of aristocratic surgery: ① fistula is easy to occur between intestinal circulations, and obstruction is easy to puncture again; ② suture is time-consuming; ③ Mild abdominal colic often occurs after operation. Child put forward an improved surgical method: after separating adhesion and arranging intestinal curvature, use a long needle and silk thread to pass through each layer of mesentery at a distance of about 3mm from the intestinal wall, and then pass through each layer of mesentery at a side opening of 3cm, and loosely ligate, but not ligate mesenteric blood vessels. Generally, 3 stitches are fixed, 2 stitches at both ends and 1 stitch in the middle. This folding and fixing operation takes about 10 minutes. Children's surgery is simple, with few complications, and its effect is better than that of aristocratic surgery, so it was quickly adopted to replace aristocratic surgery. Backing surgery and noble surgery belong to external fixation surgery. Fixation by mesenteric suture may damage mesenteric vessels. 1959, Backer reported a seamless line arrangement operation-internal stent. Its principle is to place a plastic or rubber catheter in the whole small intestine cavity, and use the stent function of the catheter to keep all bent parts of the intestine obtuse, so that even if it adheres again, it will not form an acute angle to cause obstruction. This method was put forward by White in 1956, but it was popularized by Backer. Our common method is to insert an M-A tube from the stump after appendectomy or insert it directly into the cecum after all adhesions are separated, and then inflate the balloon after entering the small intestine. Before emptying the balloon, push it to the proximal end of duodenum. Arrange the small intestine as neatly as possible to avoid bending into an acute angle, and then poke a hole in the right lower abdomen to lead out the M-A tube. M-A tube can also be inserted through nose, stomach or upper jejunostomy, and inserted into ascending colon from top to bottom. The advantage of enterostomy is to avoid long-term indwelling catheter through nasopharynx, but the disadvantage is that one more enterostomy may produce some post-ostomy complications. No matter what method is adopted, all or almost all small intestines should be supported. After operation, the stent can be maintained for more than 10 ~ 15 days, and the M-A tube can be used for decompression and drainage, and negative pressure suction can be performed through the M-A tube in acute obstruction. The internal stent does not need to be stitched, which is simple and time-saving, safe and effective. However, there are also some failure rates and complications, such as persistent gastric or intestinal paralysis, difficulty in extubation, jejunum or cecum skin fistula, persistent abdominal cramps and so on. However, intestinal obstruction rarely recurs. Weigelt in 198...> & gt

Question 3: Can intestinal obstruction be cured without surgery? If it is clear that the conservative treatment of recurrent intestinal obstruction is not effective, it is recommended to operate Peking Union Medical College Hospital-Basic Surgery-Deputy Chief Physician Kang Weiming to check the original post >>