Department of Obstetrics & Gynecology, Jewish General Hospital, the Center for Clinical Epidemiology, Lady Davis Institute, the Department of Family Medicine, and the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and the Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
Obstet Gynecol. 2018 Feb;131(2):354-359. doi: 10.1097/AOG.0000000000002440.
To evaluate the association of cesarean deliveries on the incidence of small bowel obstruction.
We formed a population-based cohort of all women with a first live birth between 1998 and 2007 using the U.K. Clinical Practice Research Datalink. Women were followed until 2015, the occurrence of a small bowel obstruction, or loss to follow-up. Cesarean delivery was identified from the Hospital Episode Statistics and small bowel obstruction events were identified using the Classification of Interventions and Procedures and International Classification of Diseases, 10th Revision codes. Cox proportional hazard models, with cesarean delivery defined as a time-dependent exposure, estimated the adjusted hazard ratios and 95% CIs of small bowel obstruction associated with cesarean delivery.
The cohort included 81,480 women with a median follow-up of 8.0 years (range 6 months to 16.6 years), during which 575 new small bowel obstructions occurred (incidence 9.1/10,000 person-years). Risk of small bowel obstruction was higher among women with a cesarean delivery compared with women without (16.3 vs 6.4 patients/10,000 person-years, odds ratio [OR] 2.54, 95% CI 2.15-3.00). Increasing number of cesarean deliveries was associated with an increasing risk of small bowel obstruction (OR 1.61, 95% CI 1.46-1.78, per additional cesarean delivery). Repeated small bowel obstructions were more common among women with a cesarean delivery and the association remained when restricting to small bowel obstruction requiring surgical management.
Although rare, small bowel obstructions are increased among women who have undergone a cesarean delivery. With increasing rates of cesarean deliveries worldwide, small bowel obstructions and related morbidities may become a more prevalent women's health concern.
评估剖宫产术与小肠梗阻发生率的关联。
我们利用英国临床实践研究数据链接，组建了一个始于 1998 年至 2007 年间的首次活产的所有女性的基于人群的队列。随访直至 2015 年，发生小肠梗阻或失访为止。剖宫产术通过医院病例统计数据确定，小肠梗阻事件通过干预分类和国际疾病分类，第 10 版代码确定。以剖宫产术为时间依赖性暴露因素，Cox 比例风险模型估计了与剖宫产术相关的小肠梗阻的调整后危险比和 95%CI。
该队列包括 81480 名女性，中位随访时间为 8.0 年（范围 6 个月至 16.6 年），在此期间发生了 575 例新的小肠梗阻（发生率为 9.1/10000 人年）。与未行剖宫产术的女性相比，行剖宫产术的女性小肠梗阻的风险更高（16.3 比 6.4 例/10000 人年，优势比[OR]2.54，95%CI 2.15-3.00）。剖宫产术的次数增加与小肠梗阻的风险增加相关（OR 1.61，95%CI 1.46-1.78，每增加一次剖宫产术）。行剖宫产术的女性更常发生重复的小肠梗阻，当限制于需要手术治疗的小肠梗阻时，这种关联仍然存在。
尽管罕见，但行剖宫产术的女性小肠梗阻的发生率增加。随着全球剖宫产率的上升，小肠梗阻和相关的发病率可能成为更普遍的女性健康问题。
