Parker J E, Fubini S L, Todhunter R J
Department of Clinical Sciences, New York State College of Veterinary Medicine, Cornell University, Ithaca.
Vet Surg. 1989 Nov-Dec;18(6):424-31. doi: 10.1111/j.1532-950x.1990.tb01118.x.
Fifty-three of 648 horses (8.2%) treated surgically for acute gastrointestinal obstruction were subjected to repeat celiotomy. Forty horses (75%) recovered from anesthesia after repeat celiotomy, and 26 horses (49%) were discharged from the clinic. Excluding two horses lost to follow-up, 10 of 51 horses (20%) survived long term. Horses subjected to repeat celiotomy had a significantly lower long-term survival rate than horses subjected to a single celiotomy. Twenty-eight horses had mechanical obstructions, and 22 had functional obstructions at the second surgery. Significantly more horses with mechanical obstructions recovered from anesthesia, but there was no difference in short-term or long-term survival. Seventy-seven percent of horses were subjected to two celiotomies without being discharged from the clinic between procedures. The intervals between primary and repeat celiotomies ranged from less than 24 hours to 4 years, with 89% of them being less than 2 months. Horses with functional obstructions at the second surgery had a significantly shorter interval between surgeries than horses with mechanical obstructions. Twenty-three horses had sequelae of the primary celiotomy, 19 had progression of their original disease, 8 had recurrence of the same condition, and 3 had unrelated problems. Intestinal ischemic necrosis was the most common diagnosis at repeat celiotomy, and small intestinal obstruction by adhesions was the second most frequent.
648匹因急性胃肠梗阻接受手术治疗的马匹中,有53匹(8.2%)接受了再次剖腹术。40匹马(75%)在再次剖腹术后从麻醉中苏醒,26匹马(49%)从诊所出院。排除2匹失访的马,51匹马中有10匹(20%)长期存活。接受再次剖腹术的马匹长期存活率明显低于接受单次剖腹术的马匹。28匹马存在机械性梗阻,22匹马在第二次手术时存在功能性梗阻。机械性梗阻的马匹从麻醉中苏醒的比例明显更高,但短期或长期存活率并无差异。77%的马匹接受了两次剖腹术,且两次手术期间未从诊所出院。初次剖腹术与再次剖腹术之间的间隔时间从不到24小时至4年不等,其中89%的间隔时间不到2个月。第二次手术时存在功能性梗阻的马匹手术间隔时间明显短于存在机械性梗阻的马匹。23匹马有初次剖腹术的后遗症,19匹马原有疾病进展,8匹马病情复发,3匹马出现无关问题。肠缺血坏死是再次剖腹术时最常见的诊断,粘连导致的小肠梗阻是第二常见的情况。