[Decision analysis in therapeutic strategies for small bowel obstructions]

Clinical decision analysis was applied in therapeutic decision-making regarding small bowel obstructions. For strangulation obstruction, the three strategies of immediate surgery, observation of clinical course, and decision according to ultrasonographic findings were analyzed. When mortality rate, morbidity rate, or duration of hospital stay was used as the utility value, decision on the basis of ultrasonographic findings was selected as the most effective strategy, while the strategy of immediate surgery was selected when the rate of intestinal necrosis was used as the utility value. For adhesive obstructions, the three strategies of immediate surgery, conservative treatment with long tube decompression, and long tube decompression with enteroclysis (infusion contrast radiography) were analyzed. The strategy of enteroclysis was selected when morbidity rate and duration of hospital stay were used as utility values, while immediate surgery was selected when recurrence rate of adhesive obstruction was used as the utility value. For obstruction caused by intraabdominal recurrent cancer, operative treatment and conservative treatment were analyzed. The strategy of surgery was selected when rate of obstruction resolved and number of months of survival were used as utility values. Clinical decision analysis is valuable in quantitatively assessing individual variables affecting therapeutic decision-making.