成人急性肠梗阻急诊手术患者103例临床特征及预后分析

Clinical characteristics and prognosis of 103 adult patients undergoing emergency surgery for acute intestinal obstruction

目的分析成人急性肠梗阻急诊手术患者的临床特征及预后。方法回顾性抽取2018年8月至2022年3月汾阳医院收治的行急诊手术治疗的急性肠梗阻成人患者103例。分析其临床资料,总结临床特征及预后。结果 103例患者年龄(61.72±8.32)岁,其中≥60岁59例(57.28%);男性35例(33.98%),女性68例(66.02%);有腹盆部手术史48例(46.60%)。病因谱以肿瘤和粘连居多,分别占31.07%(32/103)、28.16%(29/103)。103例患者均有不同程度的腹痛、腹胀、恶心呕吐、停止排气或排便等肠梗阻症状,腹部查体有压痛77例(74.76%),反跳痛及腹部紧张26例(25.24%),体温升高18例(17.48%)。腹部CT检查显示梗阻部位为小肠53例(51.46%),大肠50例(48.54%);梗阻肠道血运情况:非绞窄性75例(72.82%),绞窄性28例(27.18%);不同病因患者CT表现有明显差异。103例患者术后出现肠梗阻1例(0.97%),出血1例(0.97%),吻合口瘘1例(0.97%),经针对性处理后预后良好。结论行急诊手术的成人急性肠梗阻好发于女性,患者大多有腹盆部手术史,临床表现不典型,需要腹部CT协助诊断,肿瘤和粘连是肠梗阻主要病因,急诊手术治疗预后良好。

Objective To analyze the clinical characteristics and prognosis of adult patients undergoing emergency surgery for acute intestinal obstruction.Methods A total of 103 adult patients with acute intestinal obstruction who underwent emergency surgery in Fenyang Hospital from August 2018 to March 2022 were retrospectively selected.Their clinical data were analyzed to summarize the clinical characteristics and prognosis.Results The age of the 103 patients was(61.72±8.32)years,of which 59 cases(57.28%)were≥60 years old;35 cases of them were male(33.98%),and 68 cases(66.02%)were female;48 patients(46.60%)had a history of abdominal and pelvic surgery.Tumors and adhesions were the most common causes of disease,accounting for 31.07%(32/103)and 28.16%(29/103),respectively.All of the 103 patients had different degrees of intestinal obstruction symptoms such as abdominal pain,abdominal distension,nausea and vomiting,cessation of gas or defecation;77 cases(74.76%)had tenderness on abdominal examination,26 cases(25.24%)had rebound tenderness and abdominal tension,and 18 cases(17.48%)had elevated body temperature.Fifty-three cases(51.46%)had small intestine obstruction and 50 cases(48.54%)had large bowel obstruction according to abdominal computed tomography(CT)examination.Seventy-five cases(72.82%)had non-strangulated obstructed intestinal blood supply,and 28 cases(27.18%)had strangulated obstructed intestinal blood supply.There were significant differences in CT manifestations of patients with different etiologies.Among the 103 patients,there was 1 case intestinal obstruction(0.97%),1 case hemorrhage(0.97%),and 1 case anastomotic leakage(0.97%)after operation.After targeted treatment,all patients had good prognosis.Conclusions Acute intestinal obstruction in adults undergoing emergency surgery is more common in women.Most of them have a history of abdominal and pelvic surgery,without typical clinical manifestations.Abdominal CT is necessary in the diagnosis.Tumors and adhesions are the main causes of intestinal obstruction.Emergency surgery can get a good prognosis.