Ross Samuel W, Oommen Bindhu, Wormer Blair A, Walters Amanda L, Augenstein Vedra A, Heniford B Todd, Sing Ronald F, Christmas A Britton
Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA.
Am Surg. 2016 Feb;82(2):102-11. doi: 10.1177/000313481608200211.
Acute colonic pseudo-obstruction (ACPO) is a rare but often fatal disease. Herein, we present the largest study to date on ACPO. The National Inpatient Sample was queried for ACPO diagnoses from 1998 to 2011. Patients were analyzed by treatment into four groups: medical management (MM), colonoscopy alone [(endoscopy-only group) ENDO], surgery alone (SURG), or surgery and colonoscopy (SAC). Logistic regression was used to identify predictors of adverse outcomes by treatment group. There were 106,784 cases of ACPO: 96,657 (90.5%) MM, 2,915 (2.7%) ENDO, 6,731 (6.3%) SURG, and 481 (0.5%) SAC. The medical complication (45.7%), procedural complication (15.9%), and mortality rates (7.7%) were high. Increasing procedure invasiveness was independently associated with higher odds of medical complications, procedural complications, and death (P < 0.0125). The odds of death were significantly higher in the ENDO [odds ratio (OR) = 1.2], SURG (OR 1.4), and SAC (OR = 1.8) groups (P < 0.0125). Those who fail MM and require procedures have increasing morbidity and mortality with increasing invasiveness, likely reflecting the severity of their conditions.
急性结肠假性梗阻（ACPO）是一种罕见但往往致命的疾病。在此，我们呈现了迄今为止关于ACPO的最大规模研究。对1998年至2011年全国住院患者样本进行了ACPO诊断查询。患者按治疗方式分为四组：药物治疗（MM）、单纯结肠镜检查（[仅内镜检查组]ENDO）、单纯手术（SURG）或手术及结肠镜检查（SAC）。采用逻辑回归分析各治疗组不良结局的预测因素。共有106,784例ACPO病例：96,657例（90.5%）采用MM治疗，2,915例（2.7%）采用ENDO治疗，6,731例（6.3%）采用SURG治疗，481例（0.5%）采用SAC治疗。医疗并发症发生率（45.7%）、操作并发症发生率（15.9%）和死亡率（7.7%）都很高。操作侵入性增加与医疗并发症、操作并发症及死亡的较高几率独立相关（P < 0.0125）。ENDO组（比值比[OR] = 1.2）、SURG组（OR = 1.4）和SAC组（OR = 1.8）的死亡几率显著更高（P < 0.0125）。那些MM治疗失败且需要进行操作的患者，随着侵入性增加，发病率和死亡率也不断上升，这可能反映了他们病情的严重程度。
