Predictive factors for surgical indication in adhesive small bowel obstruction
Predictive factors for surgical indication in adhesive small bowel obstruction
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DOI：
10.1016/j.amjsurg.2007.05.048
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发表时间：
2008-07-01
影响因子：
3
通讯作者：
Ono, Koichi
中科院分区：
文献类型：
--
作者：
Tanaka, Shogo;Yamamoto, Takatsugu;Ono, Koichi
背景技术背景：腹部手术后的小肠梗阻（SBO）通常通过使用长鼻肠管（LT）进行肠减压成功治疗，但有些病例无效。方法：对53例粘连性SBO患者的临床背景和入院时的实验室资料进行回顾性分析，以确定LT减压失败的预测因素，并调查剖腹手术的适当时机。完全SBO（大肠内无空气）和血清肌酸磷酸激酶升高（>= 130 IU/L）是LT减压失败的独立预测因素。14例患者（分别为9例和5例完全性和部分性SBO）接受了剖腹手术，而39例患者（分别为9例和30例）成功进行了LT减压。完全SBO（6.3天）比部分SBO（2.6天）SBO的分辨率显着延长。结论：完全SBO或高血清肌酸磷酸激酶（CPK）的患者可能不会响应LT减压。完全性SBO和部分性SBO分别在7天和3天无反应后进行剖腹手术是合适的。(c)2008年爱思唯尔公司All rights reserved.
BACKGROUND: Small bowel obstruction (SBO) after abdominal surgery is usually treated successfully with intestinal decompression using a long nasointestinal tube (LT), but some cases fail to respond.METHODS: Clinical background and laboratory data on admission were evaluated retrospectively for 53 patients with adhesive SBO to determine predictive factors for failure of LT decompression, and the appropriate timing of laparotomy was investigated.RESULTS: Complete SBO (no evidence of air within the large bowel) and increased serum creatine phosphokinase (>= 130 IU/L) were independent predictive factors for LT decompression failure. Laparotomy was indicated in 14 patients (9 and 5 with complete and partial SBO, respectively), whereas successful LT decompression occurred in 39 patients (9 and 30, respectively). Resolution of SBO took significantly longer for complete SBO (6.3 days) than for partial SBO (2.6 days).CONCLUSIONS: Patients with complete SBO or high serum creatine phosphokinase (CPK) may not respond to LT decompression. Laparotomy is appropriate after non-response for 7 and 3 days for complete and partial SBO, respectively. (c) 2008 Elsevier Inc. All rights reserved.