少见急性肠梗阻的临床分析与策略

Clinical analysis and strategy for unusual types of acute intestinal obstructions

目的:了解少见急性肠梗阻的临床特征,为制订诊疗对策提供参考依据.方法:利用SPSS12.0统计软件包,回顾性分析我院2002.01/2006-08少见急性肠梗阻(病因构成比<3.0%)发病情况及诊治情况,病例分成3组:儿童组(0岁-,组Ⅰ),青少年与成年组(14岁-,组Ⅱ)和老年组(60岁-,组Ⅲ).结果:在338例急性肠梗阻病例中,少见急性肠梗阻是122例(36.1%).在少见急性肠梗阻中:男94例(77.0%),女28例(23.0%),病因36种(急性肠梗阻总病因数是41种),组Ⅰ31例患者,13种病因:组Ⅱ62例,26种病因:组Ⅲ29例,14种病因.组Ⅰ,Ⅱ,Ⅲ患者就诊时间分别为:2.3±1.5 h,60.0±43.2 h和84.0±67.2 h,有显著性差异(P=0.000);组Ⅰ,Ⅱ,Ⅲ患者急性生理和慢性健康评分(APACHEⅡ)分别为:2.5±1.8分,5.5±3.6分和17.8±5.8分,有显著性差异(P =0.000),3组患者的总手术治疗率为65.6%,病死9例,病死率为8.0%,组Ⅰ,Ⅱ,Ⅲ患者治愈率分别为100.0%,95.0%和79.3%,差异有显著性(P=0.000).结论:少见急性肠梗阻诊断困难,易延误治疗时机而造成高病死率;病情(局部病变与全身状况)的准确判断和有效的治疗(手术治疗与非手术治疗)是少见急性肠梗阻诊治的关键.

AIM： To explore the clinical characteristics of unusual acute intestinal obstructions, and to improve early diagnosis and treatment in such cases. METHODS： Patients with unusual acute intestinal obstructions were divided into three groups： children （n = 31）, adolescents or adults （n = 13）, and elderly （n = 29）. The incidence and conditions, acute physiology and chronic health evaluation （APACHE） score, operative rate, mortality, and cure rates of patients wihh unusual acute intestinal obstructions were analyzed retrospec- tively using SPSS12.0 statistical software. RESULTS： There were 122 （94 male, 28 female） unusual cases among 338 patients with acute intestinal obstruction. Among the 31 children, 62 adolescents or adults, and 29 elderly patients, there were 13, 26 and 14, unusual intestinal obstructions, respectively. The visiting time of patients （2.3 ±1.5 h, 60.0 ±43.2 h, 84.0 ± 67.2 h,P = 0.000）; APACHE score （2.5 ± 1.8, 5.5 ± 3.6, 17.8 ± 5.8, P = 0.000）; and cure rates （100%, 95%, 79.3%, P = 0.000） in the children, adolescents or adults, and elderly groups, respectively, showed significant differences. The surgery and mortality rates were 65.6% and 8.0%, respectively. CONCLUSION： The mortality rate for unusual acute intestinal obstructions is high because of the difficulty of making an early diagnosis and the resulting delay in instituting effective treatment. It is important to correctly evaluate the state of an illness and effectively treat unusual acute intestinal obstructions.