腹部手术中粘连松解相关的发病率。

Adhesiolysis-related morbidity in abdominal surgery.

机构信息

Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.

出版信息

Ann Surg. 2013 Jul;258(1):98-106. doi: 10.1097/SLA.0b013e31826f4969.

DOI:10.1097/SLA.0b013e31826f4969

PMID:23013804

Abstract

OBJECTIVE

To determine the incidence of bowel injury in operations requiring adhesiolysis and to assess the impact of adhesiolysis on the incidence of surgical complications, postoperative morbidity, and costs.

BACKGROUND

Morbidity of adhesiolysis during abdominal surgery seems an important health care problem, but the direct impact of adhesiolysis on inadvertent organ damage, morbidity, and costs is unknown.

METHODS

In a prospective cohort study, detailed data on adhesiolysis were gathered by direct observation during elective abdominal surgery. Comparison was made between surgical procedures with and without adhesiolysis on the incidence of inadvertent bowel defects. Secondary outcomes were the effect of adhesiolysis and bowel injury on surgical complications, other morbidity, and costs.

RESULTS

A total of 755 (out of 844) surgeries in 715 patients were included. Adhesiolysis was required in 475 (62.9%) of operations. Median adhesiolysis time was 20 minutes (range: 1-177). Fifty patients (10.5%) undergoing adhesiolysis inadvertently incurred bowel defect, compared with 0 (0%) without adhesiolysis (P < 0.001). In univariate and multivariate analyses, adhesiolysis was associated with an increase of sepsis incidence [odds ratio (OR): 5.12; 95% confidence interval (CI): 1.06-24.71], intra-abdominal complications (OR: 3.46; 95% CI: 1.49-8.05) and wound infection (OR: 2.45; 95% CI: 1.01-5.94), longer hospital stay (2.06 ± 1.06 days), and higher hospital costs [$18,579 (15,204-21,954) vs $14,063 (12,471-15,655)]. Mortality after adhesiolysis complicated by a bowel defect was 4 out of 50 (8%), compared with 7 out of 425 (1.6%) after uncomplicated adhesiolysis (OR: 5.19; 95% CI: 1.47-18.41).

CONCLUSIONS

Adhesiolysis and inadvertent bowel injury have a large negative effect on the convalescence after abdominal surgery. The awareness of adhesion-related morbidity during reoperation and the prevention of postsurgical adhesion deserve priority in research and clinical practice.

摘要

目的

确定需要粘连松解术的手术中肠损伤的发生率，并评估粘连松解术对手术并发症、术后发病率和成本的影响。

背景

腹部手术粘连松解术的发病率似乎是一个重要的医疗保健问题，但粘连松解术对无意的器官损伤、发病率和成本的直接影响尚不清楚。

方法

在一项前瞻性队列研究中，通过对择期腹部手术的直接观察，详细收集了粘连松解术的数据。比较了有粘连松解术和无粘连松解术的手术中，肠损伤的发生率。次要结果是粘连松解术和肠损伤对手术并发症、其他发病率和成本的影响。

结果

共纳入 715 例患者的 755 例（844 例）手术。475 例（62.9%）手术需要粘连松解术。粘连松解术的中位时间为 20 分钟（范围：1-177）。50 例（10.5%）行粘连松解术的患者无意中发生肠损伤，而无粘连松解术的患者无肠损伤（0%）（P<0.001）。单因素和多因素分析显示，粘连松解术与脓毒症发生率增加相关[比值比（OR）：5.12；95%置信区间（CI）：1.06-24.71]、腹腔内并发症（OR：3.46；95%CI：1.49-8.05）和伤口感染（OR：2.45；95%CI：1.01-5.94）、住院时间延长（2.06±1.06 天）和住院费用增加[$18579（15204-21954）比$14063（12471-15655）]。粘连松解术后并发肠损伤的死亡率为 50 例中的 4 例（8%），而无粘连松解术的 425 例中的 7 例（1.6%）（OR：5.19；95%CI：1.47-18.41）。