粘连性术后小肠梗阻手术后死亡率和发病率的患病率及危险因素

Prevalence and risk factors of mortality and morbidity after operation for adhesive postoperative small bowel obstruction.

作者信息

Duron Jean-Jacques, du Montcel Sophie Tezenas, Berger Anne, Muscari Fabrice, Hennet Henri, Veyrieres Michel, Hay Jean Marie

机构信息

Department of General Surgery University Hospital La Pitié, Paris, France.

出版信息

Am J Surg. 2008 Jun;195(6):726-34. doi: 10.1016/j.amjsurg.2007.04.019.

DOI:10.1016/j.amjsurg.2007.04.019

PMID:18367136

Abstract

BACKGROUND

Many factors are believed to influence the mortality and morbidity after operations for adhesive small bowel obstruction (SBO).

METHODS

In a multicenter prospective cohort of 286 patients operated on for adhesive postoperative SBO, we studied the in-hospital and 30-day postdischarge mortality (early mortality) and morbidity as well as long-term mortality using univariate and multivariate analysis.

RESULTS

In the present cohort, with a median follow-up of 41 months and 9% patients lost to follow-up at the end of the study, the prevalence of early postoperative mortality was 3%. All deceased patients were over 75 years old with an American Society of Anesthesiologists (ASA) class >/=III. The prevalence of long-term mortality was 7% with the following independent risk factors: age >75 years old (hazards ratio [HR] 6.6 [95% confidence interval [CI], 2.4-18.1]), medical complications (HR 7.4 [CI, 2.2-24.3]), and a mixed mechanism of obstruction (HR 4.5 [CI, 1.5-13.7]). Prevalence of medical and surgical morbidity was 8% and 6%, respectively. Independent risk factors for medical complications were ASA class >/=III (odds ratio [OR] 16.8 [CI, 2.1-133.1]) and bands (OR 14.1 [CI, 1.8-111.5]) and for the surgical complications the number of obstructive structures >/=10 (OR 8.3 [CI, 1.6-19.7]), a nonresected intestinal wall injury (OR 5.3 [CI, 1.5-18.3]), and intestinal necrosis (OR 5.6 [CI, 1.6-19.7]). Otherwise, 3 patients with "apparent" reversible ischemia developed a postoperative intestinal necrosis followed by 2 reoperations and 1 death.

CONCLUSION

The early postoperative mortality is strongly linked with the age and the ASA class and the long-term mortality with postoperative complications. More frequent bowel resections might be suggested for patients featuring a number of obstructive structures >/=10 and an intestinal wall injury, especially when associated with a reversible intestinal ischemia.

摘要

背景

许多因素被认为会影响粘连性小肠梗阻（SBO）手术后的死亡率和发病率。

方法

在一个包含286例接受粘连性术后SBO手术患者的多中心前瞻性队列中，我们使用单因素和多因素分析研究了住院期间及出院后30天的死亡率（早期死亡率）和发病率以及长期死亡率。

结果

在本队列中，中位随访时间为41个月，研究结束时9%的患者失访，术后早期死亡率为3%。所有死亡患者均为75岁以上，美国麻醉医师协会（ASA）分级≥III级。长期死亡率为7%，其独立危险因素如下：年龄>75岁（风险比[HR]6.6[95%置信区间[CI]，2.4 - 18.1]）、内科并发症（HR 7.4[CI，2.2 - 24.3]）以及梗阻混合机制（HR 4.5[CI，1.5 - 13.7]）。内科和外科发病率分别为8%和6%。内科并发症的独立危险因素为ASA分级≥III级（比值比[OR]16.8[CI，2.1 - 133.1]）和束带（OR 14.1[CI，1.8 - 111.5]），外科并发症的独立危险因素为梗阻结构数量≥10个（OR 8.3[CI，1.6 - 19.7]）、未切除的肠壁损伤（OR 5.3[CI，1.5 - 18.3]）以及肠坏死（OR 5.6[CI，1.6 - 19.7]）。此外，3例有“明显”可逆性缺血的患者术后发生肠坏死，随后进行了2次再次手术，1例死亡。