Gyedu Adam, Abantanga Francis, Kyei Ishmael, Boakye Godfred, Stewart Barclay T
Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Dig Surg. 2015;32(5):389-96. doi: 10.1159/000438798. Epub 2015 Aug 25.
This study aimed to describe the epidemiology and outcomes of intestinal obstruction at a tertiary hospital in Ghana over time.
Records of all patients admitted to a tertiary hospital from 2007 to 2011 with intestinal obstruction were identified using ICD-9 codes. Sociodemographic and clinical data were compared to a previously published series of intestinal obstructions from 1998 to 2003. Factors contributing to longer than expected hospital stays and death were further examined.
Of the 230 records reviewed, 108 patients (47%) had obstructions due to adhesions, 50 (21%) had volvulus, 22 (7%) had an ileus from perforation and 14 (6%) had intussusception. Hernia fell from the 1st to the 8th most common cause of obstruction. Patients with intestinal obstruction were older in 2007-2011 compared to those presenting between 1998 and 2003 (p < 0.001); conditions associated with older age (e.g., volvulus and neoplasia) were more frequently encountered (p < 0.001). Age over 50 years was strong factor of in-hospital death (adjusted OR 14.2, 95% CI 1.41-142.95).
Efforts to reduce hernia backlog and expand the surgical workforce may have had an effect on intestinal obstruction epidemiology in Ghana. Increasing aging-related pathology and a higher risk of death in elderly patients suggest that improvement in geriatric surgical care is urgently needed.
本研究旨在描述加纳一家三级医院肠梗阻的流行病学情况及长期转归。
利用国际疾病分类第九版（ICD - 9）编码，确定2007年至2011年期间入住该三级医院的所有肠梗阻患者的记录。将社会人口统计学和临床数据与先前发表的1998年至2003年一系列肠梗阻病例进行比较。进一步研究导致住院时间长于预期和死亡的因素。
在审查的230份记录中，108例患者（47%）因粘连导致梗阻，50例（21%）为肠扭转，22例（7%）因穿孔导致肠梗阻，14例（6%）为肠套叠。疝从最常见的梗阻原因第1位降至第8位。与1998年至2003年期间就诊的患者相比，2007年至2011年期间肠梗阻患者年龄更大（p < 0.001）；与老年相关的疾病（如肠扭转和肿瘤）更常见（p < 0.001）。50岁以上是院内死亡的重要因素（校正比值比14.2，95%可信区间1.41 - 142.95）。
减少疝积压和扩大外科手术人员队伍的努力可能对加纳肠梗阻的流行病学产生了影响。与衰老相关的病理情况增加以及老年患者更高的死亡风险表明，迫切需要改善老年外科护理。
