粘连性小肠梗阻后肠绞窄发生影响因素及其与术后梗阻复发的关系  

Influencing factors of intestinal strangulation after adhesive small bowel obstruction and its relation to recurrence

作　　者：杜记涛 曹建 赵稳 赵卫杰 陈广龙 万相斌 李智 DU Jitao;CAO Jian;ZHAO Wen;ZHAO Weijie;CHEN Guanglong;WAN Xiangbin;LI Zhi(Department of General Surgery,the Cancer Hospital Affiliated to Zhengzhou University,Zhengzhou 450000)

机构地区：[1]郑州大学附属肿瘤医院普外科,郑州450000

出　　处：《郑州大学学报（医学版）》2021年第5期661-665,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省医学科技攻关省部共建项目(SB201901104)。

摘　　要：目的:分析粘连性小肠梗阻(aSBO)后肠绞窄发生的影响因素,并探究肠绞窄对术后梗阻复发的影响。方法:回顾279例行手术治疗的aSBO患者的临床资料。随访7~33个月,aSBO后79例发生肠绞窄(其中术后梗阻复发30例),200例未发生肠绞窄(其中术后梗阻复发28例)。采用Logistic回归分析aSBO后肠绞窄发生的影响因素。采用Cox回归分析肠绞窄对术后aSBO复发的影响。结果:Logistic回归分析结果显示,无持续腹痛、无肠鸣音减弱、无腹膜炎、白细胞计数(10~15)×109个/L、CT示无肠壁密度降低、CT示无肠系膜肿胀增厚提示aSBO后肠绞窄发生的风险较低,OR(95%CI)分别为0.169(0.044~0.643)、0.030(0.008~0.114)、0.034(0.010~0.121)、0.161(0.044~0.583)、0.121(0.019~0.759)、0.107(0.023~0.489)。Cox回归分析结果显示,在调整了性别、年龄、腹部外伤史、腹部手术史后,肠绞窄是术后aSBO复发的危险因素,HR(95%CI)为2.155(1.266~3.671)。结论:持续腹痛、肠鸣音减弱、腹膜炎发生情况、白细胞计数、CT表现可用于评估aSBO后肠绞窄发生趋势;肠绞窄是术后aSBO复发的危险因素。Aim:To analyze the influencing factors of intestinal strangulation after adhesive small bowel obstruction(aSBO),and to explore the relation of intestinal strangulation to aSBO recurrence.Methods:The clinical data of 279 patients with aSBO who underwent surgical treatment were reviewed.The 279 patients were followed up for 7-33 months,and 79 cases developed intestinal strangulation(30 cases recurred),and 200 cases did not(28 cases recurred).Logistic regression was used to analyze the influencing factors of intestinal strangulation after aSBO,and Cox regression was used to analyze the influencing of intestinal strangulation on recurrence after aSBO treatment.Results:Logistic regression analysis showed that without persistent abdominal pain,without weakened bowel sounds,without peritonitis,white blood cell count(10-15)×109 cells/L,CT showing no decreased intestinal wall density,CT showing no mesenteric swelling and thickening indicated the low risk of intestinal strangulation after aSBO,OR(95%CI)was 0.169(0.044-0.643),0.030(0.008-0.114),0.034(0.010-0.121),0.161(0.044-0.583),0.121(0.019-0.759),0.107(0.023-0.489),respectively.Cox regression analysis showed that there was significant correlation between intestinal strangulation and recurrence after aSBO treatment,when adjusting age,gender,abdominal trauma history,abdominal surgery history,HR(95%CI)was 2.155(1.266-3.671).Conclusion:Persistent abdominal pain,weakened bowel sounds,peritonitis,white blood cell count,CT showing can be used to evaluate the occurrence of intestinal strangulation after aSBO;intestinal strangulation may be related to recurrence of aSBO after surgical treatment.

关 键 词：粘连性小肠梗阻 肠绞窄 复发 

分 类 号：R656.7[医药卫生—外科学]