肠梗阻手术干预的多因素分析及保守治疗患者随访研究

目的 探讨肠梗阻手术干预的多因素分析及内科治疗的随访.方法 回顾性分析2014年1月至2015年12月住院治疗的肠梗阻患者临床资料,将患者分为内科治疗组(n=88)和手术组(n=72),对2组临床资料进行分析,并进行随访.结果 内科治疗组住院天数明显短于手术组,差异有统计学意义(P<0.05).2组剧烈频繁呕吐、发热、腹膜炎体征、腹部包块、白细胞计数、D2聚体值、电解质紊乱、肾功能异常、低蛋白血症,影像学检查比较差异有统计学意义(P<0.05).logistic回归分析发现,剧烈频繁呕吐、腹部包块、低蛋白血症、电解质紊乱、腹腔积液、完全性肠梗阻、结肠梗阻是肠梗阻需要手术干预的影响因素.保守治疗随访发现,粘连性肠梗阻复发最多,其次为肠腔扭转、腹腔炎症引起的梗阻,肠梗阻平均缓解时间(23.16±1.56)月,6个月累计复发率为(18.4±4.8)%,第1年累计复发率为(26.8±5.8)%.COX回归法进行单因素分析发现,内科保守治疗对梗阻远期复发并无影响.结论 剧烈频繁呕吐、腹部包块、低蛋白血症、电解质紊乱、腹腔积液、完全性肠梗阻、结肠梗阻是需要手术干预的关键因素.保守治疗与肠梗阻远期复发无关联.

Multiplicity Logistic analysis of surgical treatment of intestinal obstruction and follow-up study on the patients receiving conservative treatment

Objective To investigate the predictive factors of surgical treatment for patients with intestinal obstruction and to follow-up the patients receiving conservative treatment in department of internal medicine. Methods The clinical data about 160 adult patients with intestinal obstruction who were treated in our hospital from January 2014 to December 2015 were retrospectively analyzed. These patients were divided into medical treatment group (n = 88)and surgical treatment group (n =77),the clinical data were analyzed and compared between two groups,moreover,the patients in both groups were followed up. Results The hospital days in medical treatment group were significantly shorter than those in surgical treatment group (P <0. 05). There were significant differences in the severe and frequent vomiting,fever,white blood cell count,abdominal mass, hypoalbuminemia,electrolyte imbalance,ascites,complete intestinal obstruction,colonic obstruction,image examination results between the two groups (P < 0. 05). Logistic regression analysis showed that severe and frequent vomiting,abdominal mass,hypoalbuminemia,electrolyte imbalance,ascites,complete intestinal obstruction and colonic obstruction were the influencing factors of surgical intervention. The follow-up of conservative treatment showed that the relapse rates of adhesive intestinal obstruction were the highest,next enteric cavity torsion,the intestinal obstruction caused by abdominal cavity inflammation. The average relief time of intestinal obstruction was (23. 16 ± 1. 56)m,and accumulative relapse rate of 6 months was (18. 0 ± 4. 8)%,moreover,the accumulative relapse rate of 1 year was (26. 8 ± 5. 8)% . COX regression single factor analysis showed that conservative treatment had no effects on long-term relapse of intestinal obstruction. Conclusion The severe and frequent vomiting,abdominal mass,hypoalbuminemia,electrolyte imbalance,ascites,complete intestinal obstruction and colonic obstruction are kay indexes of needing surgical intervention,moreover,conservative treatment is not related with long-term relapse of intestinal obstruction.