Freeman D E, Schaeffer D J, Cleary O B
Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, USA.
Equine Vet J. 2014 Nov;46(6):711-7. doi: 10.1111/evj.12216. Epub 2014 Jan 7.
Although many studies have described results after small intestinal resection and anastomosis in horses, few have described the outcome in horses with strangulating lesions managed without resection.
To examine short- and long-term recoveries in horses with strangulated small intestine that was judged to be viable during surgery and not resected.
Retrospective analysis of case records.
Data were reviewed from all cases (35 horses) with colic caused by small intestinal strangulation that underwent surgery between 1996 and 2011 at 2 university hospitals and that were managed without resection by 2 surgeons who used a clinical grading system to assess intestinal viability. Kaplan-Meier analyses were used to examine long-term survival.
Survival to discharge from the hospital was 100%, and post operative complications developed in 11 horses (31%). Three horses (8.6%) required repeat coeliotomy because of persistent pain with or without reflux, and they responded favourably to decompression of distended intestine. Ten horses died after discharge, and 12 were still alive at follow-up from 20 to 192 months after surgery. Information was available on 13 horses after discharge, but these were eventually lost to follow-up. Kaplan-Meier analyses yielded a median survival probability of 120 months.
A subjective method of assessing small intestinal viability in strangulated small intestine in horses, as used in this study, could reduce the need for resection and anastomosis, with the associated complications and costs. Also, the favourable post operative course in these horses provides strong evidence that early referral could avoid the need for resection and improve survival. The numbers of horses with the most severe changes that were not resected were too small to allow a conclusion that such segments should be left in place, and additional criteria might be needed to guide that decision in such cases.
尽管许多研究描述了马小肠切除与吻合术后的结果，但很少有研究描述未行切除处理的绞窄性病变马的预后情况。
研究术中判定为存活且未行切除的绞窄性小肠马的短期及长期恢复情况。
病例记录的回顾性分析。
回顾了1996年至2011年间在2所大学医院接受手术治疗的所有因小肠绞窄引起腹痛的病例（35匹马）的数据，这些病例由2名外科医生进行处理且未行切除，他们使用临床分级系统评估肠管活力。采用Kaplan-Meier分析来研究长期存活率。
出院存活率为100%，11匹马（31%）出现术后并发症。3匹马（8.6%）因持续疼痛伴或不伴有反流而需要再次剖腹探查，对扩张肠管减压后反应良好。10匹马出院后死亡，12匹马在术后20至192个月的随访中仍存活。出院后有13匹马有相关信息，但最终失访。Kaplan-Meier分析得出的中位生存概率为120个月。
本研究中使用的评估马绞窄性小肠肠管活力的主观方法可减少切除与吻合的需求以及相关并发症和费用。此外，这些马良好的术后病程有力地证明了早期转诊可避免切除的需要并提高存活率。未行切除的最严重病变马的数量过少，无法得出应保留此类肠段的结论，在这种情况下可能需要额外的标准来指导该决策。
