2011年至2021年我国416例腹内疝性肠梗阻患者临床特征及相关因素的分析

目的分析腹内疝性肠梗阻临床特征及相关因素,加强对不同类型腹内疝性肠梗阻发病特点及相关因素的认识,提高临床治疗效果。方法以“腹内疝性肠梗阻”为检索词,在中国知网、万方、维普等数据库检索发表于2011年2月至2021年2月的文献,纳入文献18篇,共计416例腹内疝性肠梗阻患者,分别总结腹内疝性肠梗阻患者的年龄、性别、临床特征、疾病类型、治疗方式及预后。结果416例腹内疝性肠梗阻患者男232例,女184例,男女比例为1.26∶1,患者年龄9~83岁,中位年龄50.83岁,以中年人为主,患者既往有手术史的381例(91.59%),手术史是患者发病的主要病因,临床表现为腹痛、腹胀373例(89.66%),恶心、呕吐360例(86.54%),肛门排气减少或停止373例(89.66%),肠鸣音亢进或存在气过水声372例(89.42%),肠鸣音减弱44例(10.58%),腹部CT是明确诊断的首选检查方法,影像学特征主要是液气平面306例(73.56%),存在血性腹水16例(3.85%)。明确诊断的有效病例306例(73.56%),手术治疗370例(88.94%),保守治疗46例(11.06%)。治愈402例(96.63%),死亡14例(3.37%),治疗不及时(内脏组织坏死、穿孔)及治疗方式不当(术后未有效抗感染或未能维持内环境的平衡)导致感染性休克、弥漫性血管内凝血是死亡主要原因。结论腹内疝性肠梗阻患者好发于男性,与既往手术史密切相关,影像学特别是CT检查可协助诊断,临床医师需提高对腹内疝性肠梗阻的诊治水平,精确掌控病情以提高临床治疗效果。

Analysis of clinical characteristics and related factors of 416 patients with internal hernia intestinal obstruction from 2011 to 2021 in China

Objective To analysis the clinical characteristics and related factors of internal hernia intestinal obstruction,and to enhance the understanding of the pathogenesis characteristics and related factors of different types of internal hernia intestinal obstruction and improve the clinical treatment effect.Methods Using“internal hernia intestinal obstruction”as the search term,we searched the literatures published from Feb.2011 to Feb.2021 on CNKI,Wanfang,VIP and other databases,we found 18 included literatures,which had complete clinical data of patients,including the age,gender,clinical features,disease types,treatment methods and prognosis of patients with internal hernia intestinal obstruction.Results Among the 416 patients with internal hernia intestinal obstruction,there were 232 males and 184 females,with a male-to-female ratio of 1.26∶1.The age of the patients ranged from 9 to 83 years old,and the median age was 50.83 years old.Most of the patients were middle-aged.381 cases(91.59%)of the patients had previous operation history,which was the main cause of the disease.There were 373 cases(89.66%)of abdominal pain and distension,360 cases(86.5%)of nausea and vomiting,373 cases(89.66%)of reduced or stopped anal exhaust,372 cases(89.42%)of hyper bowel sounds or the presence of air and water sounds,and 44 cases(10.58%)of reduced bowel sounds.Abdominal CT was the main examination method for definite diagnosis,and the imaging features were mainly liquid-gas plane in 306 cases(73.56%)and bloody ascites in 16 cases(3.85%).There were 306 effective cases(73.56%)with definite diagnosis,370 cases(88.94%)with surgical treatment and 46 cases(11.06%)with conservative treatment.402 cases(96.63%)were cured,and 14 cases(3.37%)died.The main causes of death were septic shock and diffuse intravascular coagulation caused by untimely treatment(necrosis and perforation of visceral tissue)and improper treatment(ineffective anti-infection or failure to maintain the balance of internal environment after operation).Conclusion Patients with internal hernia intestinal obstruction are more likely to occur in males,which is closely related to the previous surgical history.Especially CT examination can assist in the diagnosis.Clinicians need to improve the diagnosis and treatment level of internal hernia intestinal obstruction,and accurately control the condition to improve the clinical treatment effect.