Long-term prognosis after operation for adhesive small bowel obstruction
Long-term prognosis after operation for adhesive small bowel obstruction
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DOI：
10.1097/01.sla.0000132988.50122.de
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发表时间：
2004-08-01
影响因子：
9
通讯作者：
Viste, A
中科院分区：
文献类型：
--
作者：
Fevang, BTS;Fevang, J;Viste, A
研究目的：本研究的目的是在长达40年的随访期间确定一次或多次粘连性小肠梗阻（ASBO）发作后的复发模式。此外，我们想分析影响复发率的可能因素，并研究这些患者“日常”腹痛的程度。患者与方法：对1961 ~ 1995年在美国豪克兰大学医院行粘连性梗阻手术的500例患者的住院记录进行分析。随访患者至死亡、无随访或研究结束（2002年2月），中位随访时间为10年，最长随访时间为40年。向所有在世患者发送一份调查问卷，以获取复发和腹部主诉的信息。结果：1次ASBO术后10年累积复发率为18%，30年累积复发率为29%。对于因ASBO入院多次的患者，ASBO复发的相对风险随着先前ASBO发作次数的增加而增加。4次及以上ASBO患者的累积复发率达81%。影响复发率的其他因素还有上次ASBO发作的治疗方法（保守还是手术）以及首次ASBO手术前腹部手术的次数。与一般人群的结果相比，更多的ASBO患者在家中遭受腹痛。女性和有缠结粘连的患者对腹痛的抱怨明显多于男性和带粘连患者。结论：随着ASBO发作次数的增加，ASBO复发的风险增加。大多数ASBO复发发生在前一次ASBO发作后的5年内，但ASBO发作后10至20年仍有相当大的风险。手术治疗降低了未来因ASBO入院的风险，但无论采用何种治疗方法，手术治疗的ASBO新发作的风险是相同的。接受ASBO治疗的人似乎比正常人更容易经历腹痛，尤其是那些有粘连的人。
Aim of Study: The objective of this study was to determine the pattern of recurrence after one or more episodes of adhesive small bowel obstruction (ASBO) during a follow-up period of up to 40 years. Furthermore, we wanted to analyze possible factors with an influence on the recurrence rate and to study the magnitude of "everyday" abdominal pain among these patients.Patients and Methods: Hospital records of 500 patients operated on for adhesive obstruction at Haukeland University Hospital from 1961 to 1995 were studied. The patients were followed until death, loss to follow-up, or end of study (February 2002), with a median follow-up of 10 years and a maximum follow-up time of 40 years. A questionnaire was sent to all living patients to obtain information on recurrences and abdominal complaints.Results: The cumulative recurrence rate for patients operated once for ASBO was 18% after 10 years and 29% at 30 years. For patients admitted several times for ASBO, the relative risk of recurrent ASBO increased with increasing number of prior ASBO episodes. The cumulative recurrence rate reached 81% for patients with 4 or more ASBO admissions. Other factors influencing the recurrence rate were the method of treatment of the last previous ASBO episode (conservative versus surgical) and the number of abdominal operations prior to the initial ASBO operation. Compared to results from the general populations, more ASBO patients suffer from abdominal pain at home. Women and patients having matted adhesions have significantly more complaints about abdominal pain than men and patients with band adhesions.Conclusion: The risk of recurrence increased with increasing number of ASBO episodes. Most recurrent ASBO episodes occur within 5 years after the previous one, but a considerable risk is still present 10 to 20 years after an ASBO episode. Surgical treatment decreased the risk of future admissions for ASBO, but the risk of new surgically treated ASBO episodes was the same regardless of the method of treatment. People treated for ASBO seem to be more prone to experiencing abdominal pain than the normal population, especially those having matted adhesions.