粘连性小肠梗阻手术指征的预测因素
Predictive factors for surgical indication in adhesive small bowel obstruction.
作者信息
Tanaka Shogo, Yamamoto Takatsugu, Kubota Daisuke, Matsuyama Mitsuharu, Uenishi Takahiro, Kubo Shoji, Ono Koichi
机构信息
Department of Surgery, Ishikiriseiki Hospital, 18-28 Yayoicho, Higashiosaka 579-8026, Osaka, Japan.
出版信息
Am J Surg. 2008 Jul;196(1):23-7. doi: 10.1016/j.amjsurg.2007.05.048.
BACKGROUND
Small bowel obstruction (SBO) after abdominal surgery is usually treated successfully with intestinal decompression using a long nasointestinal tube (LT), but some cases fail to respond.
METHODS
Clinical background and laboratory data on admission were evaluated retrospectively for 53 patients with adhesive SBO to determine predictive factors for failure of LT decompression, and the appropriate timing of laparotomy was investigated.
RESULTS
Complete SBO (no evidence of air within the large bowel) and increased serum creatine phosphokinase (>or=130 IU/L) were independent predictive factors for LT decompression failure. Laparotomy was indicated in 14 patients (9 and 5 with complete and partial SBO, respectively), whereas successful LT decompression occurred in 39 patients (9 and 30, respectively). Resolution of SBO took significantly longer for complete SBO (6.3 days) than for partial SBO (2.6 days).
CONCLUSIONS
Patients with complete SBO or high serum creatine phosphokinase (CPK) may not respond to LT decompression. Laparotomy is appropriate after non-response for 7 and 3 days for complete and partial SBO, respectively.
背景
腹部手术后的小肠梗阻（SBO）通常通过使用长鼻肠管（LT）进行肠道减压而成功治疗，但有些病例对此无反应。
方法
回顾性评估53例粘连性SBO患者入院时的临床背景和实验室数据，以确定LT减压失败的预测因素，并研究剖腹手术的合适时机。
结果
完全性SBO（大肠内无气体证据）和血清肌酸磷酸激酶升高（≥130 IU/L）是LT减压失败的独立预测因素。14例患者需要进行剖腹手术（分别有9例和5例完全性和部分性SBO），而39例患者LT减压成功（分别为9例和30例）。完全性SBO的SBO缓解时间（6.3天）明显长于部分性SBO（2.6天）。
结论
完全性SBO或高血清肌酸磷酸激酶（CPK）的患者可能对LT减压无反应。对于完全性和部分性SBO，分别在无反应7天和3天后进行剖腹手术是合适的。
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