由于带状或粘连引起的急性小肠梗阻（图文演示）

10. Dissection

[点击按纽展开更多->收起->回放]

1. Strangulating band
2. Adhesion to the scarred wall
3. Multiple adhesions
Adhesions or bands between the visceral organs and the anterior abdominal wall are freed first. Dissection is performed from the last small bowel loop towards the proximal portion of the small bowel.

[点击按纽展开更多->收起->回放]

Strangulating bands are sectioned with scissors after performing bipolar cauterization.

[点击按纽展开更多->收起->回放]

Freeing of a small bowel loop adhesive to scar tissue can prove to be difficult when the loop is incarcerated in the abdominal wall. During adhesiolysis, the plane of dissection is artificial and situated at a distance from the supposed boundary of the small bowel. Care must be taken to leave some parietal tissue against it. This protects against seromuscular or mucosal leaks in the digestive wall.

[点击按纽展开更多->收起->回放]

Freeing of multiple adhesions between distended intestinal loops remains a very delicate act, because the serosa covering them has often disappeared and the plane of dissection is situated between the two muscle layers. As it is sometimes difficult to find, the exposure must be excellent and the operative act requires precision.

In the presence of an obvious adhesive obstructive site (flattened loops of small bowel coming after the obstruction and distended loops of small bowel coming before it), it is not necessary to perform total adhesiolysis of the small bowel, but only of the obstructive site. On the contrary, with a clinical picture indicating multiple adhesions without clear boundaries between flattened and distended loops of small bowel, the entire jejunoileum must be freed (frequent conversion).

11. Lavage/drainage
Intraoperative serosanguineous effusions must be aspirated.
Voiding of the small bowel is not performed.
Drainage of the peritoneal cavity is not necessary.

12. Closure
Trocars are withdrawn one by one and hemostasis of the trocar openings is carefully controlled. The musculoaponeurotic plane is closed for 10/11 mm openings only. The skin is closed in a conventional fashion using staples or suture.

[点击按纽展开更多->收起->回放]

Bowel function is generally recovered rapidly on the day following surgery. It is sometimes restored on the evening of the procedure.
There is no specific care apart from general abdominal monitoring.
Persistence of the ileus, an onset of major abdominal pain or fever should lead to a suspicion of one of the following complications:
- perforation of the small bowel by an unrecognized injury or evolutive necrosis;
- intra-abdominal collections (hematoma, abscess, etc.);
- cause of the obstruction left untreated.