粘连性小肠梗阻肠绞窄预测因素和手术干预对梗阻复发影响研究  

Predictive factors with intestinal strangulation and operative intervention for recurrence in adhesive small bowel obstruction

作　　者：王权[1] 曹雪源[1] WANG Quan;CAO Xue-yuan(Department of Gastric and Colorectal Surgery,the First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院胃结直肠外科

出　　处：《中国实用外科杂志》2019年第12期1302-1305,共4页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.81673145);吉林省科技厅科技引导计划国际科技合作项目(No.20180414055GH)

摘　　要：目的分析粘连性小肠梗阻(aSBO)发生肠绞窄的相关预测因素,并探讨手术治疗对aSBO复发的影响。方法回顾性分析2013年1月至2016年4月吉林大学第一医院胃结直肠外科收治的288例aSBO病人临床资料,采用Logistic回归分析筛选肠绞窄发生的相关因素并随访比较aSBO病人手术治疗和非手术治疗后的复发率。结果 288例中绞窄性肠梗阻37例(12.9%),单纯性肠梗阻251例(87.1%)。多因素回归分析显示:心率增快[>100次/min;OR(95%CI):4.14(1.31-13.07),P=0.015]、白细胞计数增高[>15×10~9/L;OR(95%CI):4.31(1.31-14.16),P=0.016]、腹部CT示肠系膜肿胀增厚[OR(95%CI):11.04(2.18-55.92),P=0.004]和CT示腹腔积液[OR(95%CI):28.36(9.85-81.66),P<0.01]是预测肠绞窄的独立因素。84例(29.2%)在随访期间出现肠梗阻复发,手术治疗组的复发率(21.3%,26/122)与非手术治疗组(34.9%,58/166)相比明显下降(P=0.01)。结论心率增快、白细胞计数升高、腹部CT示肠系膜肿胀增厚和腹腔积液,可作为aSBO肠绞窄发生的预测因素,外科干预可降低aSBO的复发率。Objective To analyze the predictive factors for intestinal strangulation and to identify the surgical intervention for recurrence of adhesive small bowel obstruction(aSBO).Methods A retrospective study was conducted according the database in Department of Gastric and Colorectal Surgery, the First Hospital of Jilin University. Patients with aSBO from January 2013 to April 2016 were included in the study and were subject to follow-up. The clinical factors associated with strangulating obstruction and recurrences after treatment were analyzed by using univariate and multivariate logistic regression model.Results Total of 288 aSBO patients were included. Thirty-seven(12.9%)patients hadoccurredstrangulatingobstructions,and 251(87.1%)patients had simple obstructions.Increasing heart rate[>100/min;OR(95%CI):4.14(1.31-13.07),P=0.015],increasing WBC count[>15×10^9∕L;OR(95%CI):4.31(1.31-14.16),P=0.016],CT findings of thickening or swelling of the mesentery[OR(95%CI):11.04(2.18-55.92),P=0.004],and CT showing seroperitoneum [OR(95%CI):28.36(9.85-81.66),P<0.01] were detected as independent predictive factors for intestinal strangulation. During the follow-up,84 cases(29.2%)experienced recurrence of obstruction. The recurrence rates were reduced in the operation groups compared with non-operative groups[21.3%(26/122)vs.34.9%(58/166),P =0.01].Conclusion Tachycardia,leukocytosis,CT findings of thickening or swelling of the mesentery,and CT showing seroperitoneum are considered as the predictive factors with intestinal strangulation in aSBO. Meanwhile,surgical treatments can reduce recurrence rate of aSBO patients significantly.

关 键 词：小肠梗阻 肠绞窄 预测 复发 

分 类 号：R6[医药卫生—外科学]