Pirogov Russian National Research Medical University, Moscow, Russia.
Buyanov Municipal Clinical Hospital No 12, Moscow, Russia.
Khirurgiia (Mosk). 2021(3):26-35. doi: 10.17116/hirurgia202103126.
To analyze the factors of mortality in patients with acute adhesive small bowel obstruction (ASBO).
A retrospective multiple-center study included 143 (85.6%) patients with ASBO out of 167 consecutive patients with small bowel obstruction for the period 2017-2019. All patients were divided into 3 groups: early surgery group (within 12 hours after admission), late surgery (after 12 hours), non-surgical management group. The outcomes and Kaplan-Meier survival were compared in all groups.
ASBO was resolved without surgery in 77 (53.8%) patients 19.6±17.4 (M=14) hours. In the Early Surgery Group (=36), 24 patients had strangulation, 12 ones had non-strangulated bowel obstruction. In the Late Surgery Group (=30), 15 patients had strangulation and 15 ones had no strangulation. Mortality was similar in early and late surgery (=0.287), early and late surgery in patients with strangulation (=0.940), early and late surgery in patients without strangulation (=0.76). Patients died (=10) after surgery only. Thus, postoperative mortality was 15.2%, overall mortality - 7.0%. All patients who underwent surgery after 24 hours (=14) survived. Surgery increased the mortality risk compared to non-surgical management (95% CI 0 - 15.9, =0.001). There was no effect of surgery time (more or less than 12 hours) on mortality for strangulation (95% CI 13.0-16.7, p 0.788) and non-strangulated obstruction (95% CI 29.4-5.4, =0.061), bowel resection (95% CI 33.3-14.0, =0.187), presence of bowel ischemia (95% CI 14.3-17.9, p 0.613).
Delayed surgery may be advisable in patients with ASBO and no obvious signs of strangulation due to less mortality.
分析急性黏连性小肠梗阻（ASBO）患者的死亡因素。
这是一项回顾性多中心研究，纳入了 2017 年至 2019 年期间连续收治的 167 例小肠梗阻患者中的 143 例（85.6%）ASBO 患者。所有患者均分为 3 组：早期手术组（入院后 12 小时内）、晚期手术组（12 小时后）和非手术治疗组。比较所有组的结局和 Kaplan-Meier 生存情况。
77 例（53.8%）患者无需手术即可缓解 ASBO，缓解时间为 19.6±17.4（M=14）小时。早期手术组（=36）中，24 例为绞窄性肠梗阻，12 例为非绞窄性肠梗阻。晚期手术组（=30）中，15 例为绞窄性肠梗阻，15 例为非绞窄性肠梗阻。早期和晚期手术组的死亡率相似（=0.287），早期和晚期手术组的绞窄性肠梗阻患者死亡率相似（=0.940），早期和晚期手术组的非绞窄性肠梗阻患者死亡率相似（=0.76）。仅 10 例患者术后死亡。因此，术后死亡率为 15.2%，总死亡率为 7.0%。所有术后 24 小时以上接受手术的患者均存活。与非手术治疗相比，手术增加了死亡率风险（95%CI 0-15.9，=0.001）。对于绞窄性肠梗阻（95%CI 13.0-16.7，p=0.788）和非绞窄性肠梗阻（95%CI 29.4-5.4，=0.061）、肠切除术（95%CI 33.3-14.0，=0.187）和肠缺血（95%CI 14.3-17.9，p=0.613），手术时间（早于或晚于 12 小时）并无影响。
由于死亡率较低，对于无明显绞窄迹象的 ASBO 患者，可考虑延迟手术。
