成人机械性肠梗阻手术治疗预测因素的探讨

目的:探讨成人机械性肠梗阻手术治疗的预测因素及中西医结合非手术治疗的疗效.方法:回顾性分析住院治疗的机械性肠梗阻患者,病人分为非手术治疗组和手术治疗组,临床指标、实验室检查、影像学检查作为手术治疗的预测因素采用logistic多因素回归分析,并分析中西医结合非手术治疗的疗效.结果:根据logistic多因素回归分析得出腹部包块、肠鸣音减弱、腹痛进行性加重、白细胞计数、腹部立位X线平片示梗阻肠襻固定且扩张加重5 项指标可以预测机械性肠梗阻患者是否需手术治疗.结论:患者入院或住院期间,腹部包块、肠鸣音减弱、腹痛进行性加重、白细胞计数增高、腹部立位X线平片示梗阻肠襻固定且扩张加重可能是机械性肠梗阻患者需手术治疗的预测因素.中药治疗能有效治疗腹腔粘连、复发或转移性肿瘤所致机械性肠梗阻.

Predictive factors for necessity of operative treatment in adult patients with mechanical intestinal obstruction

Objective To study the predictive factors of surgical treatment for adult patients with mechanical intestinal obstruction (MIO) and to investigate clinical results of integrated traditional Chinese and western medicine in the treatment of MIO.Methods The records of hospitalized MIO patients were prospectively reviewed.Patients with MIO were divided into a non-operative group and an operative group.The clinical,laboratory,and radiographic factors were evaluated as probable predictive factors for surgical treatment.Predictive factors associated with the surgical treatment were determined using logistic regression models.Result Five items were found by the method of forward stepwise including abdominal mass,hypoactive bowel sound,progressive abdominal pain,white blood cells counts and obstruction ansa interstinalis fixation with severe expansion by erect position abdominal X ray plain film.Conclusions Presence of abdominal mass,hypoactive bowel sound,progressive abdominal pain,increased white blood cells counts and obstruction ansa interstinalis fixation with severe expansion by erect position abdominal X ray plain film should be considered as predictive factors for an operation in MIO cases.Traditional medicine treatment plays an obvious effect in the treatment of mechanical intestinal obstruction due to intra-abdominal adhesions and recurrence or metastasis of neoplasm.