影响小肠梗阻手术预后的危险因素分析  

Analysis of risk factors affecting operative outcome of small bowel obstruction

作　　者：王中林[1] 潘忠良[1] 孙伟[1] 徐建敏 林海清 万涛 黄节 何杰 王毅 

机构地区：[1]温州市第二人民医院温州医学院定理临床学院普通外科,325027

出　　处：《中华胃肠外科杂志》2009年第5期483-486,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的 评估影响经手术治疗的小肠梗阻患者预后的危险因素。方法回顾分析经手术治疗的193例小肠梗阻患者的临床资料。结果本组小肠梗阻的病因中肠粘连占38．9％，疝占37．8％：发生肠管绞窄者42．0％，肠管坏死者23．3％。总的并发症发生率为16．1％，术后30d内死亡率为4．1％。术后中位住院时间13d。70岁以上老年人（P=0．033）、糖尿病（P=0．017）、恶性肿瘤（P=0．003）、WBC超过15×10^9／L（P=0．017）和入院与手术间隔时间（P=0．039）是绞窄性肠梗阻高发生率的独立因素；老年（P=0．031）和恶性肿瘤（P=0．013）是手术死亡率增加的独立因素；老年（P=0．016）和肠切除（P=0．017）是增加并发症发生率的独立危险因素。结论老年患者小肠梗阻的肠管绞窄发生率、术后并发症发生率和手术死亡率显著增加。Objective To evaluate the risk factors affecting the early postoperative outcomes in patients with small bowel obstruction. Methods Clinical data of 193 patients with small bowel obstruction undergone operation were analyzed retrospectively. A range of factors were investigated to estimate postoperative outcome, including gender, age, comorbidities, etiology of obstruction, presence of strangulated bowel （viable or nonviable）, leukocyte count, temperature, and heart rate. Logistic regression analysis was used to study the prognostic value of each significant variable in terms of postoperation. Results The major causes of small bowel obstruction were adhesion and hernia, contributing 38.9% and 37.8% of all cases, respectively. Strangulation occurred in 42.0% and caused nonviable bowel in 23.3% of obstructing episodes. Elderly （≥70 years）, diabetes, malignant tumors WBC 〉15×10^9/L were independent significant factors associated with bowel strangulation. The overall complication rate was 16.1%, the 30-day mortality was 4.1%, and the median postoperative hospital stay was 13 days. Age ≥70 years and bowel resection were significantly associated with postoperative complications in the univariate analysis. Only elderly and malignant obstruction were significantly associated with operative mortality in multivariate logistic regression. Conclusions Surgery for small bowel obstruction is still associated with significant mortality and morbidity. Elderly is significantly associated with an increased incidence of strangulation, operative mortality, and complications.

关 键 词：肠梗阻 外科手术 预后 

分 类 号：R656[医药卫生—外科学]