粘连性小肠梗阻患者手术治疗相关的临床和影像学特征。

Clinical and tomographic features associated with surgical management in adhesive small bowel obstruction patients.

机构信息

Departamento de Cirugía General, Centro Médico ABC, Ciudad de México, México.

出版信息

Cir Cir. 2021;89(5):588-594. doi: 10.24875/CIRU.20000716.

DOI:10.24875/CIRU.20000716

PMID:34665166

Abstract

BACKGROUND

The delay in surgical management of intestinal obstruction patients who did not respond to conservative management increases morbidity, mortality and days of hospital stay.

OBJECTIVE

This study aimed to describe the clinical and tomographic features associated with surgical management in adhesive small bowel obstruction patients.

METHOD

We conducted a retrospective review of the electronic medical records during a 5-year period with the diagnosis of adhesive small bowel obstruction. We divided patients in two, those who responded to medical management and those who required surgery.

RESULTS

A total of 162 patients were included, with a mean age of 61.5 years. It was the first case of intestinal obstruction in 63% of the patients and 65.4% underwent surgery: 52.8% (n = 56) open surgery and 47.2% (n = 50) laparoscopic surgery. Multivariate analysis showed the following predictors of surgical treatment: abdominal rebound (odds ratio [OR]: 8.8; 95% confidence interval [95% CI]: 1.09-71.6), tomographic free fluid (OR: 4.62; 95% CI: 1.50-14.20) and transition zone (OR: 5.4; 95% CI: 1.59-18.80). The history of previous obstruction was a protective factor (OR: 0.33; 95% CI: 0.17-0.67).

CONCLUSIONS

Abdominal rebound, free intrabdominal fluid and transition zone are related with the surgical management of adhesive small bowel obstruction.

摘要

背景

未对保守治疗无反应的肠梗阻患者进行手术治疗会增加发病率、死亡率和住院天数。

目的

本研究旨在描述粘连性小肠梗阻患者手术治疗相关的临床和影像学特征。

方法

我们对 5 年内电子病历中粘连性小肠梗阻的诊断进行了回顾性分析。我们将患者分为两组，一组对药物治疗有反应，另一组需要手术。

结果

共纳入 162 例患者，平均年龄为 61.5 岁。63%的患者为首次肠梗阻，65.4%的患者接受了手术治疗：52.8%（n=56）行开腹手术，47.2%（n=50）行腹腔镜手术。多变量分析显示，手术治疗的预测因素包括：腹部反弹（比值比[OR]：8.8；95%置信区间[95%CI]：1.09-71.6）、影像学游离液（OR：4.62；95%CI：1.50-14.20）和过渡区（OR：5.4；95%CI：1.59-18.80）。既往梗阻史是一个保护因素（OR：0.33；95%CI：0.17-0.67）。