非绞窄性肠梗阻手术指征研究进展

Advances in Surgical Indications for Non-Strangulated Intestinal Obstruction

摘要: 非绞窄性小肠梗阻是普外科常见急腹症，难点在于把握由保守治疗转入手术的时机。本综述按临床判断、实验室检查与影像学(CT、超声、MRI、WSCA)梳理既有研究的判定要点：症状体征与生命体征的动态变化，WBC/CRP与乳酸等指标的趋势，闭袢、肠壁强化减弱、腹腔或系膜游离液等高危征象。证据显示联合判读较单一线索更可靠，观察窗内的再评估与对比剂到达结肠等通行性信号具有辅助价值。研究同样暴露出取样与复评时点、阳性阈值、征象定义与读片一致性不统一，WSCA操作与判定流程差异明显，影响可比性与推广性。本文提炼可借鉴的判读路径与注意事项，力求为临床减少延误或过度手术提供参考。

Abstract: Non-strangulated small bowel obstruction is a common acute abdominal condition in general surgery. The challenge lies in determining the appropriate time to transition from conservative treatment to surgery. This review summarizes the key points for diagnosis based on clinical judgment, laboratory tests, and imaging (CT, ultrasound, MRI, WSCA): dynamic changes in symptoms, signs, and vital signs, trends of indicators such as WBC/CRP and lactate, high-risk signs such as closed loops, weakened intestinal wall enhancement, and free fluid in the abdominal cavity or mesentery. The evidence shows that combined interpretation is more reliable than single-line clues, and re-evaluation within the observation window and contrast agent reaching the colon and other passability signals have auxiliary value. The study also reveals inconsistencies in sampling and re-evaluation time points, positive thresholds, definition of signs and radiological consistency, significant differences in WSCA operation and determination procedures, which affect comparability and promotion. This article extracts the interpretable diagnostic paths and precautions, aiming to provide reference for clinical practice to reduce delays or excessive surgeries.