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小肠阻塞延迟手术的安全性:全国实况数据分析

Takeshi Yamada¹, Takuya Oba², Kay Uehara¹

¹Department of Gastroenterological Surgery, Nippon Medical School, Tokyo, Japan.

Journal of the American College of Surgeons

|August 29, 2025

概括

在小肠阻塞 (SBO) 超过3天的非手术治疗增加了肠切除的风险. 延长超过14天会增加吸入性肺炎的风险, 这表明早期手术是有益的.

科学领域:

胃肠病学
手术的结果
医疗服务研究

背景情况:

非手术治疗 (NOM) 是无并发性小肠阻塞 (SBO) 的常见方法.
如果NOM失败,可能会导致不良结果.
在手术前NOM的最佳持续时间尚未确定.

研究的目的:

确定SBO非操作管理的安全时间窗口.
确定与延长NOM相关的风险.
根据SBO患者的手术时间决定.

主要方法:

使用日本诊断程序组合 (DPC) 数据库 (2016-2020) 的回顾性队列研究.
包括为SBO进行手术的11,034名成年患者.
患者按从入院到手术的几天分组 (0 - 3, 4 - 7, 8 - 13, 14 - 28天).
多变量逻辑回归分析了手术时间和结果.

主要成果:

不存在重复手术或住院死亡率的显著差异.
随着NOM持续时间超过3天,肠切除率显著增加 (ORs:1. 5 - 2. 19).
随着NOM持续时间超过14天,吸气性肺炎的风险显著增加 (OR:1. 74).

结论:

长期非手术治疗SBO超过3天会增加肠切除的可能性.
延长NOM超过14天会增加吸入性肺炎的风险.
这些发现支持考虑SBO的早期手术.

关键词:

不可操作的管理现实世界数据小肠阻塞

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