術後癒着性イレウスに対するチューブ療法の経験

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  • EXPERIENCE OF TUBE THERAPY IN POSTOPERATIVE ADHESION ILEUS

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In a recent 5-year period (1986-1990), 389 patients with ileus were admitted to the department. Of the 389 cases of ileus, 347 cases were caused by mechanical obstruction including adhesion in 204, malignant tumor in 57, incarcerated hernia in 37, and other causes in 49, and the remaining 42 cases were of paralytic ileus. In this study 183 cases of ileus due to postoperative adhesion which were able to be followed were investigated for clinical and roentgenographic findings, blood analysis, effects of short and long tubes, and surgical indications. Blood analysis results were useful for diagnosis by exclusion, and for monitoring the course, but they did not appear to be decisive in selecting the treatment policy. When a short tube is used, it should be changes to a long tube within 2 days, if the abdominal findings are not improved. When a long tube is used, roentgenographic examination should be performed within a 5-day period for decision-making of surgical indication. Operation was performed in 7 out of 8 patients who had recurrence of ileus within 7 days after removal of a long tube. Severe organic stenosis was found in all 7 cases, suggesting that surgery is usually necessary in patients with early recurrence.

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