粘连性小肠梗阻手术或非手术治疗后的 1 年结果。

One-year outcomes following operative or non-operative management of adhesional small bowel obstruction.

机构信息

Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.

Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.

出版信息

BJS Open. 2023 Sep 5;7(5). doi: 10.1093/bjsopen/zrad103.

DOI:10.1093/bjsopen/zrad103

PMID:37837353

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10576245/

Abstract

BACKGROUND

A trial of initial non-operative management is recommended in stable patients with adhesional small bowel obstruction. However, recent retrospective studies have suggested that early operative management may be of benefit in reducing subsequent recurrences. This study aimed to compare recurrence rates and survival in patients with adhesional small bowel obstruction treated operatively or non-operatively.

METHODS

This was a prospective cohort study conducted at six acute hospitals in Denmark, including consecutive patients admitted with adhesional small bowel obstruction over a 4-month interval. Patients were stratified into two groups according to their treatment (operative versus non-operative) and followed up for 1 year after their index admission. Primary outcomes were recurrence of small bowel obstruction and overall survival within 1 year of index admission.

RESULTS

A total of 201 patients were included, 118 (58.7 per cent) of whom were treated operatively during their index admission. Patients undergoing operative treatment had significantly better 1-year recurrence-free survival compared with patients managed non-operatively (operative 92.5 per cent versus non-operative 66.6 per cent, P <0.001). However, when the length of index admission was taken into account, patients treated non-operatively spent significantly less time admitted to hospital in the first year (median 3 days non-operative versus 6 days operative, P <0.001). On multivariable analysis, operative treatment was associated with decreased risks of recurrence (HR 0.22 (95 per cent c.i. 0.10-0.48), P <0.001) but an increased all-cause mortality rate (HR 2.48 (95 per cent c.i. 1.13-5.46), P = 0.024).

CONCLUSION

Operative treatment of adhesional small bowel obstruction is associated with reduced risks of recurrence but increased risk of death in the first year after admission.

REGISTRATION NUMBER

NCT04750811 (http://www.clinicaltrials.gov).prior (registration date: 11 February 2021).

摘要

背景

对于稳定的粘连性小肠梗阻患者，推荐进行初始非手术治疗。然而，最近的回顾性研究表明，早期手术治疗可能有助于减少后续复发。本研究旨在比较粘连性小肠梗阻患者手术和非手术治疗后的复发率和生存率。

方法

这是在丹麦六家急性医院进行的前瞻性队列研究，包括在 4 个月的时间间隔内因粘连性小肠梗阻入院的连续患者。根据治疗方法（手术与非手术）将患者分为两组，并在索引入院后 1 年内进行随访。主要结局是小肠梗阻的复发和索引入院后 1 年内的总生存率。

结果

共纳入 201 例患者，其中 118 例（58.7%）在索引入院时接受手术治疗。与非手术治疗组相比，接受手术治疗的患者 1 年无复发生存率显著提高（手术组 92.5% vs. 非手术组 66.6%，P<0.001）。然而，当考虑到索引入院的时间长度时，非手术治疗组在第一年住院的时间明显缩短（非手术组中位数 3 天 vs. 手术组中位数 6 天，P<0.001）。多变量分析显示，手术治疗与降低复发风险相关（HR 0.22（95%置信区间 0.10-0.48），P<0.001），但全因死亡率增加（HR 2.48（95%置信区间 1.13-5.46），P=0.024）。