急性肠梗阻的病因学和病死率：705例回顾分析

doi:10.3736/jcim20081005

Abstract

Objective:

To figure out the etiological factors and overall mortality of the patients with acute intestinal obstruction, and to explore the rational period of conservative therapy before operation.

Methods:

Medical records of all the patients with acute intestinal obstruction admitted to West China Hospital from 1995 to 2002 were retrospectively reviewed. The etiology of the obstruction was categorized, and the correlation of mortality and time interval between conservative therapy and operation was analyzed.

Results:

There were 705 patients with acute intestinal obstruction included. There were 71.1% of the obstruction lesions located on the small bowel, and 82.6% of the patients experienced simple obstruction. The most frequent cause was adhesions (62.0%), and next was neoplasms (23.7%). There were 57.6% of the patients underwent the surgical treatment. The overall mortality rate was 1.6%, and the mortality rates in conservative therapy and surgical intervention groups were 1.3% and 1.7% respectively. The intestinal necrosis rate was increased gradually with the prolongation of time interval between conservative therapy and operation, and the death might occur 24 hours after strangulation.

Conclusion:

The epidemiological transition to adhesive obstruction still exists in China, and it is similar to that in Western countries. In our experience, near half of the patients with simple obstruction may achieve palliation by conservative therapy. Surgical intervention is indicated for the patients with prolonged and non-palliated simple obstruction, or strangulation disease within the first 24 hours.

Key words: intestinal obstruction, etiology, prognosis, mortality

CLC Number:

R574.2

Xin-zu Chen, Tao Wei, Kun Jiang, Kun Yang, Bo Zhang, Zhi-xin Chen, Jia-ping Chen, Jian-kun Hu. Etiological factors and mortality of acute intestinal obstruction:a review of 705 cases. Journal of Chinese Integrative Medicine, 2008, 6(10): 1010-1016.

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URL: http://www.jcimjournal.com/EN/10.3736/jcim20081005

http://www.jcimjournal.com/EN/Y2008/V6/I10/1010

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References 21

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Characteristics	n	Proportion (%)
Gender distribution
Male	390	55.3
Female	315	44.7
Lesion position
Small bowel	501	71.1
Large bowel	204	28.9
Type
Simple obstruction	582	82.6
Strangulation obstruction	123	17.4
Etiology
Adhesions	437	62.0
-Previous abdominal surgery	416	59.0
-None	21	3.0
Neoplasms	167	23.7
-Colorectal tumors	152	21.6
-Metastatic intestinal tumors	15	2.1
Incarcerated external hernias	26	3.7
Intussusception	20	2.8
Congenital intestinal diseases	19	2.7
-Congenital megacolon	16	2.3
-Congenital intestinal atresia or stenosis	3	0.4
Intestinal tuberculosis	12	1.7
Volvulus	10	1.4
Gallbladder stone in feces or gallstone	5	0.7
External compression	4	0.6
-Ovarian tumors	2	0.3
-Enlarged lymph nodes	2	0.3
Meckel's diverticulum	3	0.4
Crohn's disease	2	0.3

Time interval	n	Intestinal necrosis			Mortality
Time interval	n	Events	Stratified rate(%)	Accumulation rate(%)	Events	Stratified rate(%)	Accumulation rate(%)
<12 h	6	1	16.7	16.7	0	0	0
~24 h	16	3	18.8	18.2	0	0	0
~48 h	31	6	19.4	18.9	2	6.5	3.8
~72 h	38	10	26.3	22.0	2	5.3	4.4
≥72 h	17	9	52.9	26.9	1	5.9	4.6
Total	108	29	–	26.9	5	–	4.6

Time interval	n	Intestinal necrosis			Mortality
Time interval	n	Events	Stratified rate(%)	Accumulation rate(%)	Events	Stratified rate(%)	Accumulation rate(%)
<12 h	6	1	16.7	16.7	0	0	0
~24 h	16	3	18.8	18.2	0	0	0
~48 h	31	6	19.4	18.9	2	6.5	3.8
~72 h	38	10	26.3	22.0	2	5.3	4.4
≥72 h	17	9	52.9	26.9	1	5.9	4.6
Total	108	29	–	26.9	5	–	4.6

Reports	Period	Sample	First (%)	Second (%)	Third (%)
Ao^[7] 2002	1982-2000	866	Adhesions (30.6)	Tumor (19.9)	Hernia (15.2)
Tang et al^[8] 2002	1990-2000	599	Adhesions (70.4)	Tumor (13.5)	Hernia (–)
Wang et al^[9] 2002	1991-2000	354	Adhesions (52.5)	Tumor (25.4)	Hernia (13.8)
Zhao et al ^[10] 2002	1991-2000	504	Adhesions (33.9)	Tumor (20.6)	Hernia (14.2)
Zhu et al ^[11] 2004	1994-2003	456	Tumor (42.4)	Adhesions (31.6)	Hernia (11.6)
Tang et al ^[12] 2005	1995-2004	368	Adhesions (60.0)	Hernia (12.7)	Tumor (10.3)
Hu et al ^[13] 2006	1985-2005	346	Adhesions (62.4)	Ascarid (21.0)	Tumor (15.3)
Rui et al ^[14] 2006	1990-2005	500	Tumor (56.9)	Adhesions (30.5)	Hernia (3.4)
Bi et al ^[15] 2006	1992-2004	385	Adhesions (83.1)	Tumor (7.3)	Hernia (1.3)
Liu et al ^[16]2006	1995-2004	500	Tumor (39.0)	Adhesions (37.8)	Hernia (13.2)
Peng et al ^[4] 2007	1980-2000	1 177	Adhesions (48.8)	Tumor (28.8)	Hernia (12.2)
Zhang et al^[17] 2007	2002-2005	536	Adhesions (67.5)	Tumor (20.9 )	Hernia (6.5)
Combination		6 591	Adhesions (48.9)	Tumor (25.6)	Hernia (10.9)

Etiological factors and mortality of acute intestinal obstruction:a review of 705 cases

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