粘连性小肠梗阻的长期随访和危险因素分析

Long term follow-up and risk factors analysis of adhesive small bowel obstruction

目的比较手术和保守治疗粘连性小肠梗阻的长期随访效果。方法回顾性分析及随访南京军区南京总医院解放军普通外科研究所自2001年1月至2006年6月诊断为粘连性小肠梗阻的150例病人的临床资料。结果 150例病人住院162例次,手术治疗119例次(73.5%),保守治疗43例次(26.5%)。手术治疗组平均缓解时间为(64.5±2.1)个月,5年累积复发率为(18±5)%;保守治疗组平均缓解时间为(54.0±4.6)个月,5年累积复发率(32%±8%),组间差异具有统计学意义(P=0.020)。未发现其他危险因素对肠梗阻复发有影响。结论对于粘连性小肠梗阻,手术治疗较保守治疗更能减少肠梗阻的复发。但本研究为非对照研究,不能完全避免组间差异。

Objective To compare the long-term outcome of surgical or conservative treatment for patients with adhesive small bowel obstruction （ASBO）. Methods The clinical data of 150 patients with ASBO admitted from January 2001 to June 2006 at Research Institute of General Surgery of PLA, Nanjing General Hospital of Nanjing Command were analyzed retrospectively and followed up. Results Among the 162 admissions in 150 patients, 119 admissions （73.5%）were surgical treated and 43 admissions （26.5%）were performed conservative treatment. The mean recovery time was （64.5±2.1）months and the accumulative incidence of surgical recurrence in 5 years was （18±5） % in surgical group and those in conservative group were （54.0±4.6）m0nths and （32±8） % respectively. There was significant difference between two groups （P= 0.020）. No other independent risk factor of recurrence was found. Conclusion Surgical treatment serves as a better way in the prevention of later recurrences in patients with ASBO under certain conditions, although the strength of the conclusion may be limited due to the retrospective non-randomized nature of the study.