腹腔镜粘连松解术是否降低了小肠梗阻复发症状的风险？一项倾向评分匹配分析。

Does laparoscopic adhesiolysis decrease the risk of recurrent symptoms in small bowel obstruction? A propensity score-matched analysis.

机构信息

Department of Surgery, Kobe City Medical Center West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, 653-0013, Japan.

出版信息

Surg Endosc. 2017 Dec;31(12):5348-5355. doi: 10.1007/s00464-017-5615-9. Epub 2017 Jun 7.

DOI:10.1007/s00464-017-5615-9

PMID:28593412

Abstract

BACKGROUND

The outcomes of laparoscopic adhesiolysis for small bowel obstruction have generally been satisfactory over the short term. However, the long-term outcomes, including recurrence of symptoms and management of recurrence, remain controversial. This study compares the long-term outcomes of a series of laparoscopic and open surgery procedures for the treatment of small bowel obstruction.

METHODS

Patients who underwent adhesiolysis for small bowel obstruction at our institution between 2008 and 2015 were retrospectively reviewed. In total, 156 patients were enrolled, 78 with laparoscopic and 78 with open surgery. Propensity score matching was used to minimize the bias in patient selection. Long-term outcomes included incidence of recurrent symptoms and reoperation. In addition to the comparison of outcomes, risk factor assessment for recurrent symptoms and analysis of detailed information in patients with reoperation were performed. Statistical methods included χ test, Mann-Whitney U test, Cox proportional hazards model, and Kaplan-Meier plots with log-rank comparison.

RESULTS

Laparoscopy was performed in a younger population with milder bowel dilation and less complicated etiologies. These factors were used to construct the propensity score model, which yielded a matched cohort of 52 legs in each group. Laparoscopy achieved good short-term outcomes including early recovery of gastrointestinal function, reduced incidence of complications, and shorter hospital stay. For long-term outcomes, while the overall recurrence rate did not differ between the groups (11.5 vs 7.7%), the incidence of reoperation for recurrence was significantly higher in the laparoscopically treated group (7.7 vs 0%, p = .017). The Cox proportional hazards model showed that multiple prior surgeries (≥3 times) were a risk factor for overall recurrence (hazard ratio 7.39, p = .041).

CONCLUSION

Laparoscopic adhesiolysis did not decrease the incidence of recurrent symptoms; rather, it was related to higher incidence of recurrent small bowel obstruction requiring surgical treatment.

摘要

背景

腹腔镜粘连松解术治疗小肠梗阻的短期效果通常令人满意。然而，长期结果，包括症状复发和复发的处理，仍存在争议。本研究比较了一系列腹腔镜和开放手术治疗小肠梗阻的长期结果。

方法

回顾性分析 2008 年至 2015 年在我院行粘连松解术治疗小肠梗阻的患者。共纳入 156 例患者，腹腔镜组 78 例，开放手术组 78 例。采用倾向评分匹配法最小化患者选择的偏倚。长期结果包括症状复发和再次手术的发生率。除了比较结果外，还对症状复发的危险因素进行评估，并对再次手术患者的详细信息进行分析。统计方法包括卡方检验、Mann-Whitney U 检验、Cox 比例风险模型和 Kaplan-Meier 图与对数秩检验。

结果

腹腔镜组患者年龄较小，肠扩张较轻，病因较简单。这些因素被用于构建倾向评分模型，得到每组 52 例匹配的病例。腹腔镜手术具有良好的短期效果，包括胃肠道功能早期恢复、并发症发生率降低和住院时间缩短。对于长期结果，虽然两组的总体复发率无差异（11.5% vs 7.7%），但腹腔镜治疗组的复发再手术率明显较高（7.7% vs 0%，p=0.017）。Cox 比例风险模型显示，多次手术（≥3 次）是总体复发的危险因素（风险比 7.39，p=0.041）。