Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark.
J Gastrointest Surg. 2018 Feb;22(2):329-334. doi: 10.1007/s11605-017-3604-x. Epub 2017 Oct 13.
Postoperative adhesions are a common cause of small-bowel obstruction, and up to 53% of patients operated on for adhesive small-bowel obstruction (ASBO) experience recurrence. The primary aim of this study was to identify predictors for recurrence of ASBO.
We reviewed medical records including operation descriptions from patients who underwent emergency surgery due to ASBO at our institution between 2004 and 2013. Information on the peri- and postoperative periods, including conservatively and surgically treated recurrent ASBO, were obtained from medical records.
In total, 478 patients were included in the study. Of these, 58 (12.1%) patients experienced recurrence of ASBO during median 2.2 years follow-up. Female gender (hazard ratio [HR] 2.00, P = 0.023), multiple/matted adhesions (HR 1.72, P = 0.046), and fascial dehiscence (HR 3.26, P = 0.009) were associated with increased risk of recurrence. Conversely, intestinal resection decreased the risk of recurrence (HR 0.47, P = 0.036).
The overall recurrence rate after surgically treated ASBO was 12.1%, and the risk of recurrence was persistent several years after index operation. Factors associated with an increased risk were female gender, multiple/matted adhesions, and fascial dehiscence.
术后粘连是小肠梗阻的常见原因，多达 53%接受粘连性小肠梗阻（ASBO）手术的患者会出现复发。本研究的主要目的是确定 ASBO 复发的预测因素。
我们回顾了 2004 年至 2013 年期间在我院因 ASBO 接受急诊手术的患者的病历，包括手术描述。从病历中获得围手术期信息，包括保守和手术治疗的复发性 ASBO。
共有 478 例患者纳入研究。其中，58 例（12.1%）患者在中位 2.2 年的随访期间出现 ASBO 复发。女性（风险比 [HR] 2.00，P = 0.023）、多发/粘连（HR 1.72，P = 0.046）和筋膜裂开（HR 3.26，P = 0.009）与复发风险增加相关。相反，肠切除术降低了复发的风险（HR 0.47，P = 0.036）。
手术后 ASBO 的总体复发率为 12.1%，并且在指数手术后数年仍存在持续的复发风险。与复发风险增加相关的因素是女性、多发/粘连和筋膜裂开。
