Besler Evren, Teke Emre, Akkuş Doğukan, Demir Mahmut Hüdai, Aksaray Sebahat, Aydın Aksu Sibel, Gürleyik Meryem Günay
General Surgery Clinic, Haydarpaşa Numune Education and Research Hospital, Istanbul, Türkiye.
Department of Microbiology and Central Laboratory, Haydarpaşa Numune Education and Research Hospital, Istanbul, Türkiye.
Ann Surg Treat Res. 2023 Sep;105(3):165-171. doi: 10.4174/astr.2023.105.3.165. Epub 2023 Sep 1.
Cases of adhesive small bowel obstruction are a nuisance to surgeons. There have been years of ongoing discussions, and various guidelines have been published for the management of this disease. Both surgical and conservative approaches can have their own complications. It is often difficult to decide which treatment to apply to which patient. We aimed to create a multiparametric scoring system for the optimal management of adhesive small bowel obstruction patients.
The retrospective laboratory, clinical and radiological records of 100 patients who were hospitalized and followed-up/treated for adhesive small bowel obstruction secondary to surgery in the General Surgery Clinic of Haydarpaşa Numune Education and Research Hospital (Istanbul) between 2011 and 2021 were reviewed and statistically analyzed.
Admittance CRP and the largest diameter of the small intestine in the horizontal section of the admittance CT scans were significantly higher (P = 0.006 and P = 0.007), and the admittance albumin and sodium values were significantly lower (P < 0.001 and P = 0.031) in patients operated on for adhesive small bowel obstruction than in patients not operated on. Free intraperitoneal fluid in CT scans was detected at a higher rate in the operated group. An adhesive small bowel obstruction surgery score above 3.5 points out of 7 was found to be significant (P < 0.001).
With this easy and applicable scoring system, complications of existing disease may be avoided by considering earlier surgical intervention in patients with a score of 4 and above.
粘连性小肠梗阻病例对外科医生来说是个麻烦事。多年来一直在进行相关讨论，并且已经发布了各种关于该疾病管理的指南。手术和保守治疗方法都可能有其自身的并发症。通常很难决定对哪个患者应用哪种治疗方法。我们旨在创建一个多参数评分系统，用于粘连性小肠梗阻患者的最佳管理。
回顾并统计分析了2011年至2021年间在海达尔帕夏努穆内教育和研究医院（伊斯坦布尔）普通外科门诊因手术后粘连性小肠梗阻住院并接受随访/治疗的100例患者的实验室、临床和放射学记录。
接受粘连性小肠梗阻手术的患者入院时的CRP以及入院CT扫描水平断面小肠的最大直径显著更高（P = 0.006和P = 0.007），而入院时的白蛋白和钠值显著更低（P < 0.001和P = 0.031）。手术组CT扫描中腹腔内游离液体的检出率更高。发现粘连性小肠梗阻手术评分在7分制中高于3.5分具有显著意义（P < 0.001）。
通过这个简单且适用的评分系统，对于评分4分及以上的患者，考虑早期手术干预可以避免现有疾病的并发症。
