Asbun H J, Pempinello C, Halasz N A
Department of Surgery, Veterans Administration Medical Center, San Diego, California.
Int Surg. 1989 Jan-Mar;74(1):23-7.
We present a retrospective analysis of 105 instances of small bowel obstruction (SBO) in 80 patients admitted to our hospital over a ten year period. Adhesions accounted for 73% of the cases and secondary involvement by malignancy for 13%. Appendectomy, colorectal and other pelvic procedures were the most frequent surgical antecedents responsible for the adhesions. In the 86% of cases with a temperature over 100 degrees F there was significant morbidity, mortality and/or strangulation, and this sign also foretold a prolonged hospital stay. Leukocytosis, when present along with abdominal tenderness also predicted a prolonged hospital stay. Strangulation occurred in 4.7% of the instances and was accompanied by at least one of the "classical symptoms". Fourty-five percent of the instances were successfully managed by conservative measures alone, whereas 55% had had surgical treatment. The mean hospital stay for all cases was 15.3 days. The morbidity rate for this series was 21% with a mortality of 3.8%. The largest single cause of death was related to malignant disease (three of four cases). When post-operative adhesions were the etiology, the hospital stay was 8.5 +/- 1.3 days for those treated with conservative measures compared with 16.5 +/- 1.8 days for those in whom a surgical procedure was performed (p less than 0.0001). This latter group also has a higher morbidity (32% compared to 5% for the non-operative group).
我们对我院在十年期间收治的80例患者的105例小肠梗阻（SBO）进行了回顾性分析。粘连占病例的73%，恶性肿瘤继发累及占13%。阑尾切除术、结直肠及其他盆腔手术是导致粘连最常见的手术史。在体温超过100华氏度的病例中，86%存在显著的发病率、死亡率和/或绞窄，且该体征也预示住院时间延长。白细胞增多症伴腹部压痛时也预示住院时间延长。绞窄发生在4.7%的病例中，并伴有至少一种“典型症状”。45%的病例仅通过保守治疗成功处理，而55%接受了手术治疗。所有病例的平均住院时间为15.3天。该系列的发病率为21%，死亡率为3.8%。最大的单一死亡原因与恶性疾病相关（4例中的3例）。当术后粘连是病因时，接受保守治疗的患者住院时间为8.5±1.3天，而接受手术治疗的患者住院时间为16.5±1.8天（p＜0.0001）。后一组的发病率也更高（32%，而非手术组为5%）。
