不同策略治疗粘连性小肠梗阻的临床分析

Clinical analysis of different treatment strategies for adhesive small bowel obstruction

目的 通过分析不同策略治疗完全性粘连性小肠梗阻(adhesive small bowel obstruction,ASBO)的临床数据,探讨单气囊小肠镜对ASBO的疗效价值。方法 回顾性分析2013年1月至2020年12月郑州大学第一附属医院收治的完全性ASBO患者,比较手术治疗、保守治疗及单气囊小肠镜治疗的效果及预后。结果 360例完全性ASBO患者中,86例患者在入院的24 h内进行了手术治疗,剩余的274例患者接受了单气囊小肠镜治疗或保守治疗。保守治疗患者改为手术治疗的指征包括:梗阻不能缓解,临床状况恶化,或影像学改变提示病情严重。急诊手术组与延迟手术组相比,在术中发现及并发症预后方面差异无统计学意义(P>0.05)。单气囊小肠镜治疗组的总有效率显著高于保守治疗组(P<0.05)。保守治疗组、单气囊小肠镜治疗组与急诊手术组在入院白细胞及放疗病史方面差异有统计学意义(P<0.05)。结论 急诊手术在术中发现及术后并发症方面并不优于延迟手术,单气囊小肠镜是一种安全、有效的治疗ASBO的消化内镜手段。

Objective To evaluate the clinical significence of single balloon enteroscopy( SBE) in treatment of adhesive small bowel obstruction( ASBO),by analyzing the clinical data of different treatment strategies for ASBO.Methods Patients admitted with complete ASBO from Jun.2013 to Dec.2020 were included.Complication rates and outcomes were compared between patients managed with and those managed initially with nonoperative strategies.Results Of 360 patients admitted with complete ASBO,86 patients had surgery within 24 hours of admission.The remaining 220 patients had a trial of nonoperative management lasting at least 24 hours,54 patients received SBE treatment.Among the patients having surgery more than 24 hours after admission,indications for surgery were generally failure to resolve,worsening clinical status,and change in imaging findings.There were no statistically significant differences in the outcomes between immediate group and delayed group.Delaying operative management did not affect surgical findings or complication rates.The overall rate of successful SBE treatment was much higher than nonoperative treatment(P<0.05),SBE group,nonoperative group and immediate group had significant difference in the WBC and history of abdominal radiation(P< 0.05).Conclusion There are no differences in complication rates,including postoperative mortality,bowel resection,and stoma creation,between patients initially managed nonoperatively and those who are taken immediately to surgery.SBE is a new strategy for the treatment of ASBO.