急性肠梗阻的病因及治疗分析

Acute intestinal obstruction: etiology and treatment

目的探讨急性肠梗阻的病因和外科治疗方式.方法回顾性分析2012年5月至2017年5月于复旦大学附属中山医院行手术治疗的721例急性肠梗阻患者的临床资料,结果在721例急性肠梗阻患者中,男女比例为1:55:1;老年组占48.8%,中青年组占51.1%;肿瘤性371例,粘连性168例,疝70例,堵塞性42例,其他原因70例中青年组和老年组嵌顿疝的发生率差异有统计学意义(4.6%比15.1%,χ2=22.4,P<0.05),老年组中的肿瘤和嵌顿疝患者住院时间多于中青年组[(15.3±8.6)d比(13.4±6.3)d,t=-2.5,P<0.05;(10.1±6.7)d比(6.4±2.9)d,t二-2.2,P<O.05],肿瘤性肠梗阻限期手术患者住院时间少于急诊手术患者[(16±12)d比(18±24)d,t=-0.3,P>0.05].结论肿瘤和肠粘连是急性肠梗阻的主要病因。小肠或近端结肠肿瘤性肠梗阻需要急诊手术解除梗阻.

Objective To explore the etiology and treatment of acute intestinal obstruction. Methods Clinical data of patients who underwent operation for acute intestinal obstruction in Zhongshan Hospital from May 2012 to May 2017 were collected and retrospectively analyzed. Results 721 patients were included and the ratio of males to females was 1.55: 1. There were 48. 8% in old-aged group and 51. 1 % in young-middle-aged group. The most common causes of ileus included tumor in 376 cases (51.5%), adhesion in 168 cases ( 23. 3%), hernia in 70 cases ( 9. 7%), intraluminal obstruction in 42 cases (5. 8%) and others in 79 cases. There was a significant differenee between incarcerated hernia in elderly group and middle-young-aged group ( 4.6% vs. 15. 1%,= 22. 4, P <0.01). The length of hospitalized clays in patients with tumor and incarcerated hernia in elderly group were significantly longer than young-middle-aged patients [( 15. 3 ± 8. 6 ) d vs.( 13.4 ± 6.3 ) d, t =- 2. 5 , P < 0. 05;( 10.1 ± 6. 7) d vs.(6. 4 ±2. 9)(1, t =- 2.2 , P<0. 05 ]. The length of hospitalized days by limited operation in patients with tumor were significantly shorter than those by emergency operation [(16 ± 12 ) d vs.( 18 ± 24) d, t =- 0. 3 , P〉0.()5 ]. Conclusion Tumor and adhesion are the main causes of acute intestinal ohstmetion. Neoplastic bowel obstruction from small intestine or proximal colon requires emergency surgery.