Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan.
Surg Today. 2022 Nov;52(11):1627-1633. doi: 10.1007/s00595-022-02495-7. Epub 2022 Mar 25.
Early management is crucial for acute intestinal blood flow disorders; however, no published study has identified criteria for the time limit for blood flow resumption. This study specifically examines the time factors for avoiding intestinal resection.
The subjects of this retrospective cohort study were 125 consecutive patients who underwent emergency surgery for a confirmed diagnosis of intestinal strangulation (n = 86), incarceration (n = 27), or volvulus (n = 12), between January 2015 and March 2021. Intestinal resection was performed when intestinal irreversible changes had occurred even after ischemia was relieved surgically. We analyzed the relationship between the time from computed tomography (CT) imaging to the start of surgery (C-S time) and intestinal resection using the Kaplan-Meier method and calculated the estimated intestinal rescue rate. Patient background factors affecting intestinal resection were also examined.
The time limit for achieving 80% intestinal rescue rate was 200 min in C-S time, and when this exceeded 300 min, the intestinal rescue rate dropped to less than 50%. Multivariate analysis identified the APACHE II score as a significant influencing factor.
A rapid transition from early diagnosis to early surgery is critical for patients with acute abdomen originating from intestinal blood flow disorders. The times from presentation at the hospital to surgery should be reduced further, especially for severe cases.
急性肠道血流紊乱的早期处理至关重要，但目前尚无研究确定血流恢复的时间限制标准。本研究旨在明确避免肠切除的时间因素。
本回顾性队列研究纳入了 2015 年 1 月至 2021 年 3 月期间因肠绞窄（n=86）、嵌顿（n=27）或肠扭转（n=12）接受紧急手术的 125 例连续患者。当手术缓解缺血后出现不可逆肠改变时，进行肠切除术。我们采用 Kaplan-Meier 法分析 CT 成像至手术开始时间（C-S 时间）与肠切除的关系，并计算估计的肠挽救率。还检查了影响肠切除术的患者背景因素。
C-S 时间达到 80%肠挽救率的时间限制为 200 分钟，当超过 300 分钟时，肠挽救率降至 50%以下。多变量分析确定急性生理和慢性健康评分 II（APACHE II）评分为显著影响因素。
对于因肠道血流紊乱引起的急性腹痛患者，从早期诊断到早期手术的快速过渡至关重要。应进一步缩短从就诊到手术的时间，特别是对严重病例。
