小肠梗阻保守治疗与手术治疗的比较

作     者：Williams S.B. Greenspon J. Young H.A. Orkin B.A. 陈云茹 

作者机构：Division of Colon and Rectal Surgery 2150 Pennsylvania Avenue N.W. Washington DC 20037 United StatesDr. 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2005年第1卷第11期

页      面：8-9页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：小肠梗阻 肠梗阻患者 阑尾切除术 结肠直肠 疝修补术 剖腹探查术 胃旁路术 胆囊切除术 复发率 复发时间 

摘      要：PURPOSE: The aim of this study was to assess incidence, risk factors, and recurrence rates for conservative and surgical management of small bowel obstruction. METHODS: Retrospective chart review was conducted of 329 patients accounting for 487 admissions with small bowel obstruction. Data were obtained from the institutional database and patient charts. Patients with early recurrent small bowel obstruction had prior operations or hospitalization with conservative therapy for small bowel obstruction, then had a hospital stay 10 days following abdominal surgery because of obstruction or required readmission for small bowel obstruction within 30 days. Patients treated for prior small bowel obstruction and then readmitted after 30 days for a recurrent small bowel obstruction were classified as having late recurrent small bowel obstruction. RESULTS: A total of 329 patients with a diagnosis of small bowel obstruction were identified. At index admission, 43 percent (142) were successfully treated conservatively, wh-ereas 57 percent (187) failed conservative treatment and underwent surgery. Overall, there were eight early deaths, four in each group (2.8 percent conservative vs. 2.1 percent surgical; no significant difference). The frequency of recurrence for those treated nonoperatively was 40.5 percent compared with 26.8 percent for patients treated operatively (P 0.009). Patients treated without operation had a significantly shorter time to recurrence (mean, 153 vs. 411 days; P 0.004) and had fewer hospital days for their index small bowel obstruction (4.9 vs. 12.0 days; P 0.0001). Two hundred one (63 percent) patients had abdominal surgery and 119 (37 percent) patients had no prior abdominal surgery before developing a small bowel obstruction. Previous abdominal operations by procedure type were colorectal surgery (34 percent), gynecologic surgery (28 percent), exploratory laparotomy (20 percent), appendectomy (14 percent), cholecystectomy (12 percent), herniorra