肠梗阻 ppt演示课件
《肠梗阻 ppt演示课件》由会员分享,可在线阅读,更多相关《肠梗阻 ppt演示课件(37页珍藏版)》请在装配图网上搜索。
肠 梗 阻,INTESTINAL OBSTRUCTION RuiJin hospital Zhang Haobo,1,.,Introduction,肠内容物不能正常运行, 顺利 通过肠道。,2,.,病 因 学,机械性梗阻肠腔阻塞:结石、粪块、异物肠管受压:粘连带、肠扭转、疝 肠壁病变:肿瘤、炎性、先天性动力性肠梗阻麻痹性:神经、毒素、炎性痉挛性:肠动力紊乱、铅中毒血运性肠梗阻肠系膜血管栓塞或血栓形成,肠梗阻是否伴血运障碍单纯性/绞窄性肠梗阻部位高位:空肠上段低位:回肠末段结肠梗阻肠梗阻程度:不完全性/完全性发展进程:急性/慢性,3,.,4,.,5,.,病理生理,6,.,病理生理,7,.,Clinical Appearance,腹痛 呕吐 便秘 停止排气,8,.,Physical Examination,视 诊 腹张 Abdomen distention 蠕动波 Peristalic wave 手术疤痕 Surgical scars 嵌顿疝 Incarcerated hernias,触 诊 腹张腹块腹肌紧张腹膜炎,9,.,Physical Examination,腹部听诊肠鸣音亢进直肠指检,10,.,Laboratory Tests,血浆电解质和PH值 Blood WBC Hematocrit Serum amylase BUN ,11,.,X射线检查 Radiologic Examination,诊断正确率 8085% 平卧位 立位 侧卧位 急性完全性机械性梗阻,12,.,13,.,14,.,15,.,16,.,17,.,18,.,19,.,20,.,Radiologic Examination,小肠梗阻 Small intestinal OB小肠黏膜呈鱼刺样valvulae conniventes肠段位于腹中部central portions 小量/无结肠气体minimal /no colonic gas,结肠梗阻Colon Obstruction结肠袋影colonic haustral marking扩张肠段位于腹部外周/盆腔 periphery of abdomen/in the pelvic,21,.,1.有否肠梗阻?Does the patient have bowel obstruction? 2.梗阻在那一段肠段If so , where is it? 3.病因是什么?What is the anatomic and pathologic nature ? 4.是否存在绞榨性肠梗阻Has strangulation occurred? 5.患者全身情况如何?What is the general condition of the patients?,诊 断 Diagnosis,22,.,临床表现 Clinical Appearance,腹痛 Abdominal pain 呕吐 Vomiting 便秘 Obstipation 腹张 Abdominal distention 停止排气 Failure to pass flatus,23,.,鉴别近端和远端梗阻 Differentiation of Proximal / distal SBO:pain: epigastric / periumbilical area vomiting: prominent / later onsetdistention: no / predominate,鉴别部分梗阻和完全性梗阻 Differentiation of partial from complete SBOPartial SBO: pass flatus or liquid stoolsComplete SBO: obstipation,24,.,单纯性和绞榨性肠梗阻的鉴别,单纯性肠梗阻腹痛 阵发性 轻度-中度 呕吐 较少 休克 无,少见 发热 不常见 腹痛和肌卫 少见 对补液治疗 有效,绞榨性肠梗阻腹痛 持续性 重度 呕吐 严重 休克 早、常见 发热 明显 腹痛和肌卫 早、明显 对补液治疗效果 差,25,.,治 疗 Treatment of SBO,保守治疗和手术治疗Medical and surgical management 三个连续的阶段:观察、治疗、手术The overlapping sequence :investigation resuscitation operation手术时机的把握: The timing of operation depends on three factors:病程 duration 重要器官的功能opportunity of vital organ function 绞榨的可能 risk of strangulation,The timing of operation depends on three factors:病程 duration 器官功能 opportunity of vital organ function绞榨的可能 risk of strangulation,26,.,Medical managment,胃肠减压 Nasointestinal /nasogastric intubation 纠正水电解质的紊乱 Intravenous fluids /blood plasma administration 广谱抗菌素的应用 Broad-spectrum antibiotics administration,27,.,Surgical principle,病因The nature of problem determines approach to management of SBO. 肠管活性的判断:色泽、活力、动脉搏动The criteria of determining bowel viability:color motility arterial pulsation 处理If questionable , released and placed ,re-examined.,28,.,29,.,结肠梗阻 Large Bowel Obstruction,病因学 Etiology carcinoma 55% volvulus 11% diverticulitis 9% extrinsic carcinoma 8% adhesions 4% fecal impaction 3%,30,.,Daignosis,慢性梗阻 Chronic complaints 腹痛位于下腹部和脐周Pain related to lower abdomen or periumbilical area. 腹胀明显 Abdominal distension prominent 隐血试验 Guaiac-positive stools 直肠指检 Rectal examination,31,.,Management,直肠乙状结肠镜 Proctosigmoidoscopyvisualized/biopsied/decompressed 结肠梗阻大多数需要手术治疗Most large bowel obstruction need surgery expcet for fecal impaction 闭襻性梗阻需急症手术Closed loop obstruction need emergency 分期手术one/two/three -stage surgical procedures,32,.,肠粘连 Adhesive obstruction,形成: 粘连锐角 纤维束带压迫surgical trauma infections bleeding intestinal ischemia chemical trauma foreign bodies (powder) 肠坏死 Risk of strangulation: 9% 再次手术 肠排列手术 ( M-A管),33,.,疝源性肠梗阻,外疝: 下腹痛, 腹外疝好发部位肿块 ,无法回纳手术松解疝环, 疝修补, 坏死肠段切除。内疝: 疝环为先天或手术形成腹内间隙. 多为闭襻性, X线平片仅为一致密影 .症状剧烈, 病情急骤, 诊断困难, 需急诊手术,34,.,肠套叠 Intussusception,Intussusceptum telescopes into an intussuscipiens(sheath) enteroenteral ,ileocecal,ileocolic ,colocolic children rate is high 1/3 cases of adults is malignanciesresection is necessary ( 香肠状, 空虚感, 粘液血便),35,.,肠扭转 Volvulus,Most patient are elderly men sigmoid 60%70% psychiatric disorders and chromic laxative abuse gangrenous colon must resect sigmoid volvulus proctossigmoidoscopy,36,.,肠系膜血管缺血性疾病,急性、慢性肠系膜缺血和非闭塞性缺血 病因:栓子来源心梗、房颤等心源疾病 临床:症状和体征不相符(早期特点) 诊断:早期诊断困难 CT(+)、DSA 治疗困难,预后差 死亡率50%,37,.,- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 肠梗阻 ppt 演示 课件
装配图网所有资源均是用户自行上传分享,仅供网友学习交流,未经上传用户书面授权,请勿作他用。
关于本文