影响小肠梗阻手术预后的危险因素分析

目的 评估影响经手术治疗的小肠梗阻患者预后的危险因素。方法回顾分析经手术治疗的193例小肠梗阻患者的临床资料。结果本组小肠梗阻的病因中肠粘连占38．9％,疝占37．8％：发生肠管绞窄者42．0％,肠管坏死者23．3％。总的并发症发生率为16．1％,术后30d内死亡率为4．1％。术后中位住院时间13d。70岁以上老年人（P=0．033）、糖尿病（P=0．017）、恶性肿瘤（P=0．003）、WBC超过15×10^9／L（P=0．017）和入院与手术间隔时间（P=0．039）是绞窄性肠梗阻高发生率的独立因素;老年（P=0．031）和恶性肿瘤（P=0．013）是手术死亡率增加的独立因素;老年（P=0．016）和肠切除（P=0．017）是增加并发症发生率的独立危险因素。结论老年患者小肠梗阻的肠管绞窄发生率、术后并发症发生率和手术死亡率显著增加。     

不同手术松解时机对小肠梗阻手术预后影响及危险因素

目的 探讨不同松解手术时机对小肠梗阻手术预后影响及危险因素。方法 选择2013年1月至2014年6月收治45例粘连性小肠梗阻患者,随机分为两组,保守组20例,在发病48 h后接受松解手术;手术组25例,在发病48 h内接受松解手术。采用SPSS19.0软件进行统计分析,肠坏死率、病死率等行χ2检验,术后恢复时间采用t检验,P<0.05差异有统计学意义。结果 术后平均恢复时间:手术组(10.8±3.3)d明显少于保守组(18.3±4.1)d(t=7.95,P<0.05);术后肠坏死病例,手术组2例(8.0%)明显少于保守组4例(20.0%)(χ2=9.39,P<0.05);两组相比差异均有统计学意义。总有效率:保守组90.0%(18/20),手术组92.0%(23/25)(χ2=0.09,P>0.05);手术组2例死亡(8.0%),保守组2例死亡(10.0%),差异均无统计学意义P>0.05。结论 观察患者临床症状、体征及其演变情况,结合相应辅助检查结果,严格掌握手术指征,准确把握手术时机,可以减少小肠梗阻并发症,降低病死率。     

用胃癌的预后因素分析胃癌术后肠梗阻

病史报告刘医师：患者，女，60岁。4年前因一胃体部低分化腺癌”在我院治疗，行“根治性全胃切除术、局部淋巴结D3切除术”，术中见胃体部后壁溃疡型肿块，浆膜面可见侵犯，未发现肝、腹膜等远处转移。术后病理检查报告：胃体部低分化腺癌侵犯浆膜层（S1），癌肿大小为5cm×5cm，切除淋巴结1、3～9、12～16组，共检出淋巴结104枚，HE染色及免疫组化染色共发现转移淋巴结4枚，计算转移度为3．85％（4／104），转移淋巴结位于第3组和第5组。术后按FAM方案化疗6个月共6个疗程。病人出院后恢复较好，4年来食欲可，无腹痛、恶心等不适，大便每…     

老龄肠梗阻病人急诊手术并发症发生的危险因素分析及对策

目的探讨老龄肠梗阻病人急诊术后并发症发生的危险因素和处理策略。方法回顾性分析解放军第一〇五医院普外科2010年1月至2015年12月间行急诊手术干预57例老龄肠梗阻病人围手术期临床资料。结果 57例病人的年龄为70~105岁,平均(78.3±7.3)岁,其中24例病人(42.1%)发生了各种并发症48例次,包括肺部感染9例,术后肠梗阻3例,切口感染11例,急性肾损伤2例,低蛋白血症17例,心律失常6例。术前合并低蛋白血症、高血糖、贫血、营养不良及手术时间较长的病人术后容易出现常见手术并发症,而年龄、心脑血管疾病、水电解质紊乱及酸碱失衡则对此无明显影响。结论术前多种因素引起了病人术后并发症的出现,与病人术前各种合并疾病、病变本身因素以及手术方式的选择有关,没有单一的绝对因素决定术后并发症的出现。加强对老龄病人合并疾病的围手术期处理是减少老龄肠梗阻病人术后早期并发症的重要措施之一。     

影响癌性肠梗阻病人预后的多因素分析

目的 ：多因素分析影响癌性肠梗阻（malignant bowel obstruction, MBO）病人预后的危险因素,构建MBO病人生存期预测的列线图模型。方法：回顾性分析我院2013年6月至2019年6月203例MBO病人的临床资料及随访。结果：随访143例（70.4%）病人。单因素分析结果显示,性别、年龄、血小板、C反应蛋白、总蛋白含量、合并症数量、使用生长抑素治疗、肠内营养和肠外营养治疗、住院时间与MBO病人的生存无相关性。肿瘤TNM分期晚（P<0.001）、肿瘤继发转移（P<0.001）、贫血（P=0.001）、低白蛋白（P<0.001）、高白细胞（P=0.023）、非手术治疗（P=0.013）、生活质量评分低（P<0.001）以及肝功能差[包括高丙氨酸转氨酶（P=0.023）、高天冬氨酸转氨酶（P=0.005）]等因素与预后差有关。多因素分析显示,肿瘤分期（P=0.003）、白蛋白水平（P=0.001）是影响MBO病人预后的独立危险因素。采用TNM晚期、继发肿瘤以及血红蛋白低和白蛋白低4个指标构建的列线图。通过40例病人3～12个月的内部预测生存期,...     

腹腔镜治疗结肠癌合并肠梗阻的临床效果及预后影响因素分析

探讨腹腔镜治疗结肠癌合并肠梗阻的临床效果及预后影响因素。选取2015年6月至2016年6月我院收治的88例结肠癌合并肠梗阻患者为研究对象,随机分为研究组（44例,行腹腔镜结肠癌根治术）和对照组（44例,行开腹结肠癌根治术）。比较两组围术期指标,包括手术时间、术中出血量、切口长度、术后肛门排气时间、术后住院时间;术前和术后1、3 d血清炎症因子,包括肿瘤坏死因子（TNF-α）、C-反应蛋白（CRP）、白介素-6(IL-6)、白介素-10(IL-10);氧化应激指标,包括丙二醛（MDA）、超氧化物歧化酶（SOD）;能量代谢指标,包括前清蛋白（PA）、清蛋白（ALB）、转铁蛋白（TRE）、视黄醇结合蛋白（RBP）水平;术后并发症发生情况,术后3年内肿瘤复发、转移及生存情况。采用多因素Logistic回归模型分析影响腹腔镜下治疗结肠癌合并肠梗阻预后的因素。研究组手术时间、术后肛门排气时间、术后住院时间均短于对照组,术后出血量、切口长度均低于对照组,临床有效率高于对照组,术后并发症发生率低于对照组,差异均具有统计学意义（P <0.05）。与术前相比,两组术后1、3 d的TNF-α、CRP、...     

重型高血压脑出血手术治疗预后的影响因素

目的 探讨影响重型高血压脑出血手术治疗预后的因素。方法 对１２４例重型高血压脑出血患者进行开颅手术治疗。结果 手术疗效满意。其中,痊愈４０例,生活基本自理２４例,轻残２２例,重残１８例,植物状态２例,死亡１８例。结论 血肿部位及类型、血肿量、术前意识状态,手术时机及方法、并发症的防治是影响手术疗效的主要因素。     

左半结直肠癌并肠梗阻的外科治疗及预后分析

目的探讨左半结直肠癌并肠梗阻的外科治疗及其影响预后的因素。方法回顾性分析2001年1月至2006年12月间在青岛大学医学院附属医院行外科治疗的93例左半结直肠癌并肠梗阻患者的临床资料。结果93例患者中男53例,女40例;中位年龄61岁;其中51例合并内科疾病。行根治性切除术67例。其中一期切除吻合21例、Hartmann手术35例、Miles手术11例;行姑息性手术26例,其中单腔或双腔造瘘术14例,短路手术7例．姑息性切除5例。93例患者均获随访,1、3、5年生存率分别为94％、59％、38％。单因素和多因素预后分析显示,手术根治性、TNM分期和术前CEA水平是影响患者预后的独立因素（均P〈0．05）。结论手术根治性、TNM分期和术前CEA水平是左半结直肠癌并肠梗阻患者预后影响因素：早期诊治、根治性手术及合理地选择手术方式有助于提高患者生存率。     

Ileal or ileocecal resection for chronic radiation enteritis with small bowel obstruction: outcome and risk factors

Background

The choice of the optimum surgical procedure for chronic radiation enteritis (CRE) has not reached a consensus over the years. This study aimed to evaluate the outcomes in patients undergoing ileal or ileocecal resection for CRE and to identify predictive risk factors for postoperative complications.

Methods

Univariate and multivariate analyses of a retrospectively gathered database (2001 to 2011) were performed on a cohort of patients (N = 158) undergoing ileal or ileocecal resection for CRE obstruction at a single institution.

Results

Overall and major morbidity rates were 57.0% (90 patients) and 28.5% (45 patients), respectively. Surgical complications occurred in 20 patients (12.7%) and postoperative permanent parenteral nutrition dependence was 12.1% (12 of 99 patients). Multivariate analysis determined that an American Association of Anesthesiologists' score of III or higher, anemia, low platelet level, intraoperative transfusion, presence of radiation uropathy, and experience of surgeons were independent risk factors for Clavien-Dindo grades III to V morbidity.

Conclusions

Ileal or ileocecal resection for CRE has an acceptable risk of permanent intestinal failure and surgical complications. This study also provides the 1st evidence of predictive risk factors for postoperative morbidity of ileal or ileocecal resection for CRE.     

小肠梗阻术后感染性并发症危险因素分析

目的 讨论小肠梗阻术后感染性并发症的危险因素,以减少术后感染.方法 回顾分析2006年1月-2012年12月于首都医科大学宣武医院接受手术治疗的154例小肠梗阻患者的临床资料.Logistic回归分析术后感染性并发症的独立危险因素.结果 154例小肠梗阻患者接受手术治疗,术后感染率27.9％.回归分析发现,患者年龄（≥65岁）（OR 6.71,95％ CI3.15 ～ 16.33）、术中肠管破裂（OR2.71,95％CI1.19～7.25）、延迟（≥72 h）手术（OR 11.33,95％ CI 4.62 ～ 20.20）及手术时间（≥180 min）（OR 2.90,95％CI 1.26 ～9.83）是影响感染性并发症发生的危险因素.结论 术后感染是小肠梗阻术后的常见并发症.早期手术、术中轻柔操作防止肠管破裂可能是减少术后感染的有效措施.     

Predicting the outcome of closed-loop small bowel obstruction by preoperative characteristics

BACKGROUNDClosed-loop small bowel obstruction (CL-SBO) can threaten the viability of the intestine by obstructing a bowel segment at two adjacent points. Prompt recognition and surgery are crucial.AIMTo analyze the outcomes of patients who underwent surgery for CL-SBO and to evaluate clinical predictors.METHODSPatients who underwent surgery for suspected CL-BSO on computed tomography (CT) at a single center between 2013 and 2019 were evaluated retrospectively. Patients were divided into three groups by perioperative outcome, including viable bowel, reversible ischemia, and irreversible ischemia. Clinical and laboratorial variables at presentation were compared and postoperative outcomes were analyzed.RESULTSOf 148 patients with CL-SBO, 28 (19%) had a perioperative viable small bowel, 86 (58%) had reversible ischemia, and 34 (23%) had irreversible ischemia. Patients with a higher age had higher risk for perioperative irreversible ischemia [odds ratio (OR): 1.03, 95% confidence interval (CI): 0.99-1.06]. Patients with American Society of Anaesthesiologists (ASA) classification ≥ 3 had higher risk of perioperative irreversible ischemia compared to lower ASA classifications (OR: 3.76, 95%CI: 1.31-10.81). Eighty-six patients (58%) did not have elevated C-reactive protein (> 10 mg/L), and between-group differences were insignificant. Postoperative in-hospital stay was significantly longer for patients with irreversible ischemia (median 8 d, P = 0.001) than for those with reversible ischemia (median 6 d) or a viable bowel (median 5 d). Postoperative morbidity was significantly higher in patients with perioperative irreversible ischemia (45%, P = 0.043) compared with reversible ischemia (20%) and viable bowel (4%).CONCLUSIONOlder patients or those with higher ASA classification had an increased risk of irreversible ischemia in case of CL-SBO. After irreversible ischemia, postoperative morbidity was increased.     

Critical operative management of small bowel obstruction

The records of 238 patients with the diagnosis of small bowel obstruction at the University of Illinois Hospital from 1967 through the spring of 1976 were reviewed. Mortality, intra-operative management, and clinical findings were evaluated. Previous reports list a mortality of gangrenous small bowel obstruction, secondary to hernia and/or adhesions, as greater than 20%, although in this series, the mortality was 4.5% in patients with gangrenous small bowel obstruction. The present data reveal a 60% incidence of wound infection in patients in whom an enterotomy (iatrogenic, decompressive or resective) was made and the subcutaneous tissue and skin closed, and it is therefore recommended that the wound be left open in these situations. Although a variety of individual clinical findings have been advocated as diagnostic aids in patients with small bowel obstruction, this review suggests that attention to a combination of "classic" findings, i.e., leukocytosis, fever, tachycardia and localized tenderness, portends a situation in which conservative observation is safe--namely, the absence of all four findings. The presence of any one or more of these findings mandates early operative intervention.     

Prevalence and risk factors of mortality and morbidity after operation for adhesive postoperative small bowel obstruction

BACKGROUND: Many factors are believed to influence the mortality and morbidity after operations for adhesive small bowel obstruction (SBO). METHODS: In a multicenter prospective cohort of 286 patients operated on for adhesive postoperative SBO, we studied the in-hospital and 30-day postdischarge mortality (early mortality) and morbidity as well as long-term mortality using univariate and multivariate analysis. RESULTS: In the present cohort, with a median follow-up of 41 months and 9% patients lost to follow-up at the end of the study, the prevalence of early postoperative mortality was 3%. All deceased patients were over 75 years old with an American Society of Anesthesiologists (ASA) class >/=III. The prevalence of long-term mortality was 7% with the following independent risk factors: age >75 years old (hazards ratio [HR] 6.6 [95% confidence interval [CI], 2.4-18.1]), medical complications (HR 7.4 [CI, 2.2-24.3]), and a mixed mechanism of obstruction (HR 4.5 [CI, 1.5-13.7]). Prevalence of medical and surgical morbidity was 8% and 6%, respectively. Independent risk factors for medical complications were ASA class >/=III (odds ratio [OR] 16.8 [CI, 2.1-133.1]) and bands (OR 14.1 [CI, 1.8-111.5]) and for the surgical complications the number of obstructive structures >/=10 (OR 8.3 [CI, 1.6-19.7]), a nonresected intestinal wall injury (OR 5.3 [CI, 1.5-18.3]), and intestinal necrosis (OR 5.6 [CI, 1.6-19.7]). Otherwise, 3 patients with "apparent" reversible ischemia developed a postoperative intestinal necrosis followed by 2 reoperations and 1 death. CONCLUSION: The early postoperative mortality is strongly linked with the age and the ASA class and the long-term mortality with postoperative complications. More frequent bowel resections might be suggested for patients featuring a number of obstructive structures >/=10 and an intestinal wall injury, especially when associated with a reversible intestinal ischemia.     

Laparoscopic adhesiolysis for small bowel obstruction

BACKGROUND: Historically, laparotomy and open adhesiolysis have been the treatment for patients requiring surgery for small bowel obstruction. Laparoscopic adhesiolysis has not gained wide acceptance. The indications and outcomes of laparoscopic adhesiolysis for small bowel obstruction are not well established. The purpose of this paper is to review the literature on laparoscopic adhesiolysis for small bowel obstruction and to discuss patient selection, surgical technique, and outcomes. DATA SOURCES: Medline search from 1980 to 2002. CONCLUSIONS: Laparoscopic adhesiolysis has been shown to be safe and feasible in experienced hands. For selected patients, laparoscopic adhesiolysis offers the advantages of decreased length of stay, faster return to full activity, and decreased morbidity. Patient selection and surgical judgment appear to be the most important factors for a successful outcome.     

腹腔镜诊断和治疗小肠不全梗阻的临床研究

目的探讨腹腔镜诊断和治疗小肠不全梗阻的可行性、有效性及安全性。方法回顾性分析我院2003年2月-2007年6月因小肠梗阻接受腹腔镜治疗53例的临床资料。结果本组53例中,完成腹腔镜肠粘连分解术33例;行腹腔镜肠粘连分解术及相应肠道手术18例,其中,纯腹腔镜手术11例,腹腔镜下切口定位并开放手术7例。中转开腹手术2例。腹腔镜探查诊断率达98．11％。术后有8例发生不同类型的并发症。结论腹腔镜诊断和治疗小肠不全梗阻是安全、可行的,可以选择性应用于部分小肠不全梗阻病例。