Wilson M S, Hawkswell J, McCloy R F
University Department of Surgery, Manchester Royal Infirmary, UK.
Br J Surg. 1998 Sep;85(9):1294-8. doi: 10.1046/j.1365-2168.1998.00822.x.
The aim of this study was to identify patients admitted with adhesional obstruction to determine if there was an identifiable pattern to the type of initial operation, the type of treatment used for the obstructive episode and the subsequent need for further treatment.
Patients with adhesional obstruction were identified retrospectively in a cross-sectional study using ICD codes relating to admissions in the years 1990 to 1996. The case notes were used to assess their outcome.
Fifty-nine case notes from a total of 175 identified initially satisfied the inclusion criteria. These patients had a mean age at presentation of 51 (range 16-88) years and had undergone a total of 122 operations. Thirty-one patients (53 per cent) had a single previous operation with a median time to presentation with obstruction of 5.5 years (range 11 days to 34.7 years); 33 patients (56 per cent) were treated conservatively on their first admission. There was no statistically significant difference in the outcome in patients who received either conservative or surgical treatment. The length of stay in patients treated surgically (median 11 (range 2-47) days) was significantly longer than that for those treated conservatively (median 6 (range 1-39) days) (P< 0.001). A flow chart was constructed demonstrating the eventual outcome of the patients in the study, enabling the cost of adhesional obstruction to be calculated.
This type of approach could be used to assess the potential effect of different treatment strategies for adhesional obstruction.
本研究旨在确定因粘连性肠梗阻入院的患者，以判断初次手术类型、梗阻发作时所采用的治疗方式以及后续进一步治疗需求是否存在可识别的模式。
在一项横断面研究中，通过与1990年至1996年入院相关的国际疾病分类（ICD）编码，对粘连性肠梗阻患者进行回顾性识别。利用病历评估其治疗结果。
最初识别出的175例患者中，59例病历符合纳入标准。这些患者就诊时的平均年龄为51岁（范围16 - 88岁），共接受了122次手术。31例患者（53%）此前接受过一次手术，出现梗阻症状的中位时间为5.5年（范围11天至34.7年）；33例患者（56%）首次入院时接受了保守治疗。接受保守治疗或手术治疗的患者在治疗结果上无统计学显著差异。接受手术治疗的患者住院时间（中位时间11天（范围2 - 47天））显著长于接受保守治疗的患者（中位时间6天（范围1 - 39天））（P < 0.001）。构建了一个流程图，展示了研究中患者的最终治疗结果，从而能够计算粘连性肠梗阻的治疗成本。
这种方法可用于评估粘连性肠梗阻不同治疗策略的潜在效果。
