Sigua B V, Zemlyanoy V P, Petrov S V, Qalandarova D H, Efimov A L
I.I.Mechnikov North-Western State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation, e-mail:
Adv Gerontol. 2021;34(1):33-38.
Adhesive small bowel obstruction is a common pathology with a tendency to increase characterized by a complex pathogenetic course with a high percentage of complications and deaths. Among the forms of intestinal obstruction caused by mechanical obstacles acute small bowel obstruction ranges from 64,3 to 80% with a mortality rate of 5,1 to 8,4% in the structure of urgent diseases. The complexity of early diagnosis along with an erased clinical picture severe course against a burdened background as well as age - in elderly and senile people leads to the search for new optimized treatment and diagnostic protocols. The purpose of this study was to study the nature of the course of adhesive small bowel obstruction in elderly and senile people to establish the information content of various diagnostic methods to determine the indications for the choice of the optimal period and method of treatment. A comparative analysis of 191 patients aged 60 to 90 years and older who received treatment in the surgical departments of St. Elizabeth Hospital (St. Petersburg) in the period from 2016-2019 was carried out. All patients were divided into 2 groups: the main group consisted of 106 patients (2018-2019) the comparison group included 85 patients (2016-2017). All patients of the main group used an improved diagnostic and treatment algorithm with the use of an original point-assessment scale which made it possible to optimize diagnostics and improve treatment results. Patients in the comparison group were examined in accordance with standard protocols and surgical treatment was carried out exclusively by traditional methods. The use of the proposed therapeutic and diagnostic algorithm made it possible to increase the probability of conservative resolution of acute adhesive small bowel obstruction from 20% (17) to 33% (35) and to reduce the incidence of postoperative complications from 60,2% (41) to 25,3% (18), p<0,01, and the mortality rate from 23,5% (16) to 7% (5), p<0,05.
粘连性小肠梗阻是一种常见且有增加趋势的病理状况，其致病过程复杂，并发症和死亡率比例较高。在由机械性障碍引起的肠梗阻类型中，急性小肠梗阻占64.3%至80%，在急症疾病结构中的死亡率为5.1%至8.4%。早期诊断的复杂性，加上临床症状不典型、病情严重且伴有复杂背景以及患者年龄（老年人和高龄老人）等因素，促使人们寻找新的优化治疗和诊断方案。本研究的目的是研究老年人和高龄老人粘连性小肠梗阻的病程特点，确定各种诊断方法的信息量，以确定选择最佳治疗时期和方法的指征。对2016 - 2019年期间在圣伊丽莎白医院（圣彼得堡）外科接受治疗的191例60岁至90岁及以上患者进行了比较分析。所有患者分为2组：主要组由106例患者组成（2018 - 2019年），比较组包括85例患者（2016 - 2017年）。主要组的所有患者采用了改进的诊断和治疗算法，并使用了原始的评分量表，这使得优化诊断和改善治疗结果成为可能。比较组的患者按照标准方案进行检查，手术治疗完全采用传统方法。使用所提出的治疗和诊断算法能够将急性粘连性小肠梗阻保守治疗成功的概率从20%（17例）提高到33%（35例），并将术后并发症的发生率从60.2%（41例）降低到25.3%（18例），p<0.01，死亡率从23.5%（16例）降低到7%（5例），p<0.05。
