60岁及以上急性肠梗阻急诊手术治疗289例患者的病因分析

Etiological analysis of acute intestinal obstruction requiring surgical intervention elderly patients

回顾分析2010年6月至2020年12月在南京医科大学鼓楼临床医学院住院手术的289例≥60岁急性肠梗阻患者临床资料。289例患者肠梗阻的病因分别为肿瘤97例(33.6%)、腹外疝66例(22.8%)、粘连44例(15.2%)、扭转36例(12.5%)、腹内疝20例(6.9%)、套叠8例(2.8%)、其他病因18例(6.2%)。156例绞窄性肠梗阻患者的病因分别为腹外疝51例(32.7%)、扭转36例(23.1%)、粘连26例(16.7%)、腹内疝18例(11.5%)、肿瘤14例(9.0%)、套叠8例(5.1%)及其他病因3例(1.9%);39例(88.6%)粘连、17例(85.0%)内疝、22例(61.1%)扭转者有腹部手术史。肿瘤引起的小肠梗阻(5例)、绞窄性肠梗阻(14例)及绞窄性大肠梗阻(12例)均少于相应的大肠梗阻(92例)、非绞窄性肠梗阻(80例)及非绞窄性大肠梗阻(83例)(均P<0.05);腹外疝(51例)、扭转(36例)、腹内疝(18例)及套叠(8例)引起的绞窄性梗阻,多于相应的非绞窄性梗阻(15例、0例、2例、8例,均P<0.05);腹外疝(4例)、扭转(9例)引起的绞窄性大肠梗阻,多于相应的非绞窄性大肠梗阻(1例、0例,均P<0.05);粘连(26例)和扭转(27例)引起的绞窄性小肠梗阻显著多于非绞窄性小肠梗阻(18例、0例,均P<0.05)。提示肠道肿瘤和腹外疝分别是≥60岁急性肠梗阻和绞窄性肠梗阻患者急诊手术的首要病因。

Clinical data of 289 patients aged 60 years old and above with acute intestinal obstruction operated in Drum Tower Hospital during June 2010 to December 2020 were analyzed retrospectively.Among 289 cases,97 cases(33.6%)had tumor,66(22.8%)had external hernias,44(15.2%)had adhesions,36(12.5%)had volvulus,20(6.9%)had internal hernias,8(2.8%)had intussusception and 18(6.2%)had other causes.Of 156 strangulated intestinal obstruction cases,51 cases(32.7%)had external hernias,36(23.1%)had volvulus,26(16.7%)had adhesions,18(11.5%)had internal hernias,14(9.0%)had tumor,8(5.1%)had intussusception,and 3(1.9%)had other causes.There was a history of abdominal surgery in 88.6%(39/44)cases of adhesion,85.0%(17/20)cases of internal hernia and 61.1%(22/36)cases of volvulus.For patients with acute intestinal obstruction caused by intestinal tumor,the cases of small bowel obstruction,strangulated intestinal obstruction and the strangulated large bowel were significantly less than those of large bowel obstruction,the non-strangulated intestinal obstruction and the non-strangulated large bowel obstruction(5 vs.92,14 vs.80,12 vs.83,respectively;all P<0.05).For patients with strangulated intestinal obstruction caused by external hernias,volvulus,internal hernias and intussusception were significantly more than those with non-strangulated intestinal obstruction groups(51 vs.15,36 vs.0,18 vs.2,8 vs.0,respectively;P<0.05).The patients with strangulated large bowel obstruction caused by external hernias(n=4)and volvulus(n=9)were significantly more than those with non-strangulated large bowel obstruction(n=1 and 0,respectively;P<0.05).The patients with strangulated small bowel obstruction caused by adhesions(n=26)and volvulus(n=27)were significantly more than those with non-strangulated small bowel obstruction(n=18 and 0,respectively;P<0.05).The study showed that the principal causes of emergency operation for acute intestinal obstruction and strangulated intestinal obstruction are intestinal tumor and external hernias in elderly patients.