| 标题： | 闭袢性小肠梗阻诊断与治疗中国急诊专家共识 |
| title： | Chinese emergency expert consensus on diagnosis and treatment of closed loop small bowel obstruction |
| 版本： | 原创版 |
| version： | Original |
| 分类： | 专家共识 |
| classification： | Experts consensus |
| 领域： | 诊疗 |
| field： | Diagnosis and Treatment |
| 国家和地区： | 中国 |
| Country and region： | China |
| 指南使用者： | 普通外科医生和急诊外科医生 |
| Guide users： | General surgeons and emergency physicians |
| 证据分级方法： | 本专家共识采用GRADE 协作网的指南分级标准对证据进行分级，并采用国际通行的改良 Delphi 方法组织专家投票，修订达成相关推荐意见。表决意见分为 6 级：1 级：完全同意（100%）；2 级：基本同意（80%）；3 级：部分同意（60%）；4 级：部分反对（40%）；5 级：较多反对（20%）；6 级：完全反对（0）。推荐等级根据专家投票分为强推荐、弱推荐 2 个级别：“完全同意”票数超过 80% 为强推荐；“完全同意”+“基本同意”票数超过 80% 为弱推荐。 |
| Evidence grading method： | This expert consensus adopts the GRADE Collaboration's guideline grading standard to grade the evidence, and adopts the internationally accepted modified Delphi method to organize expert voting to revise and reach the relevant recommendations. The voting opinions were divided into 6 levels: Level 1: complete agreement (100%); Level 2: basic agreement (80%); Level 3: partial agreement (60%); Level 4: partial opposition (40%); Level 5: more opposition (20%); Level 6: complete opposition (0). Recommendation level is divided into 2 levels of strong recommendation and weak recommendation according to the votes of experts: "totally agree" with more than 80% of votes is strong recommendation; "totally agree" + "basically agree" with more than 80% of votes is weak recommendation. |
| 制定单位： | 青岛大学附属医院；福建医科大学附属协和医院;陆军军医大学第一附属医院;中国人民解放军总医院第四医学中心 |
| Formulating unit： | Affiliated Hospital of Qingdao University；Fujian Medical University Union Hospital;The First Affiliated Hospital of Army Military Medical University;The Fourth Medical Center of the Chinese People's Liberation Army General Hospital |
| 注册时间： | 2024-09-04 |
| Registration time： | |
| 注册编号： | PREPARE-2024CN392 |
| Registration number： | |
| 指南制订的目的： | 闭袢性小肠梗阻是一种常见的外科急腹症、特殊类型的小肠梗阻，需要早期诊断、尽早干预，一旦漏诊或延误治疗，将导致肠坏死、肠穿孔、急性弥漫性腹膜炎，甚至死亡等严重并发症。由于梗阻和缺血的程度不同，闭袢性小肠梗阻除了肠梗阻经典的“痛、吐、胀、闭”的症状外，还常有腹部包块、顽固性休克等症状。由于缺乏对闭袢性小肠梗阻影像学的系统阐述，目前的诊断极大地依赖于高年资外科医师和影像科医师的交互阅片和多学科讨论。手术解除闭袢狭窄环、切除缺血坏死的肠袢是目前临床常用的治疗策略，已基本达成业内共识；然而手术时机、手术术式的抉择、保守方案的个体化仍待进一步的讨论。 |
| Purpose of the guideline： | Closed loop small bowel obstruction is a common surgical acute abdomen, a special type of small bowel obstruction, which requires early diagnosis and early intervention. Once missed diagnosis or delayed treatment, it will lead to serious complications such as intestinal necrosis, intestinal perforation, acute diffuse peritonitis, and even death. Due to the different degree of obstruction and ischemia, in addition to the classic symptoms of "pain, vomiting, distension, closure" of intestinal obstruction, there are often abdominal mass, intractable shock and other symptoms. Due to the lack of systematic imaging of occlusion-loop ileus, current diagnosis relies heavily on interactive film review and multidisciplinary discussion between senior surgeons and radiologists. Surgical removal of occlusive loop and resection of intestinal loop with ischemic necrosis are currently common clinical treatment strategies, which have basically reached a consensus in the industry. However, the timing of surgery, the choice of surgical methods, and the individualization of conservative plans remain to be further discussed. |
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