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结直肠手术后粘连性小肠梗阻

Adhesional small bowel obstruction after colorectal surgery.

作者信息

Ryan Matthew D, Wattchow David, Walker Margaret, Hakendorf Paul

机构信息

Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia.

出版信息

ANZ J Surg. 2004 Nov;74(11):1010-2. doi: 10.1111/j.1445-1433.2004.03225.x.

Abstract

BACKGROUND

Acute clinical indicators of complications in colorectal surgery can be readily attained but it is much harder to gather indicators of long-term outcomes such as small bowel obstruction (SBO). However, with improved in-hospital data collection and coding such information is becoming available. The aim of the present study was to examine our own hospital database for SBO rates post-colorectal surgery.

METHODS

The database was searched and then the relevant medical records were reviewed of all patients admitted to Flinders Medical Centre (Bedford Park, Australia) between July 1999 and November 2002 with a diagnosis of SBO following a colorectal procedure during this same time period.

RESULTS

There were 21 patients that accounted for 28 readmissions from a total colorectal procedure group of 583 patients. The arbitrary subgroups were: 13/325 (4%) for colonic resections; 7/186 (3.7%) for rectal resections; 0/12 (0%) for laparotomies/other procedures; and 1/39 (2.6%) for stoma formation/reversals. The overall SBO rate requiring readmission was therefore 3.6%/pt in the 3 years. There was a large variation in the first readmission interval, 38% occurred within 3 months, 43% between 3 and 12 months, and 19% after 1 year. At the first readmission 38% of patients had operative treatment. The mean length of stay was 6.12 days for non-operative vs 21.62 days for operative treatment.

CONCLUSION

The reported rate of SBO of 3.6% (at 3 years time interval) is in accordance with other studies. With 38% of patients being treated operatively at first admission there is good acceptance for conservative management in non-strangulated SBO. The prolonged hospital stay for patients needing surgery warrants further investigation.

摘要

背景

结直肠手术并发症的急性临床指标易于获取,但收集诸如小肠梗阻(SBO)等长期预后指标则困难得多。然而,随着医院数据收集和编码的改进,此类信息正变得可用。本研究的目的是检查我们自己医院数据库中结直肠手术后的SBO发生率。

方法

检索数据库,然后回顾了1999年7月至2002年11月期间入住弗林德斯医疗中心(澳大利亚贝德福德公园)且在此期间因结直肠手术诊断为SBO的所有患者的相关病历。

结果

在总共583例结直肠手术患者中,有21例患者导致28次再次入院。任意亚组情况如下:结肠切除术患者中13/325例(4%);直肠切除术患者中7/186例(3.7%);剖腹术/其他手术患者中0/12例(0%);造口形成/造口回纳患者中1/39例(2.6%)。因此,3年期间需要再次入院的总体SBO发生率为3.6%/患者。首次再次入院间隔时间差异很大,38%发生在3个月内,43%发生在3至12个月之间,19%发生在1年后。首次再次入院时,38%的患者接受了手术治疗。非手术治疗的平均住院时间为6.12天,而手术治疗为21.62天。

结论

报告的SBO发生率为3.6%(3年时间间隔)与其他研究一致。首次入院时38%的患者接受手术治疗,对于非绞窄性SBO的保守治疗有较好的接受度。需要手术的患者住院时间延长值得进一步研究。

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