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目的:总结急性肠梗阻的病因学类型和总体病死率,探索手术治疗前合理的保守治疗时间。方法:回顾性分析了华西医院1995年至2002年的住院病人病历,分类统计各类病因,并分析病死率与手术前保守治疗间期的相关性。结果:共纳入705例急性肠梗阻病例,其中71.1%病变部位在小肠,82.6%为单纯性肠梗阻。最常见病因为粘连(62.0%),肿瘤次之(23.7%)。56.7%的病例接受外科治疗。总体病死率为1.6%,其中保守治疗组为1.3%,外科治疗组为1.7%。肠坏死发生率随保守治疗间期延长而增高,当绞窄发生超过24 h即可能死亡。结论:与西方相似,在中国同样有病因向粘连性转移的流行病学趋势。基于四川大学华西医院经验,近半数的单纯性肠梗阻病例可经保守治疗缓解。保守治疗延长且无缓解趋势的单纯性肠梗阻,或绞窄发生第一个24 h内的病例应接受外科治疗。
OBJECTIVE: To summarize the etiological types and overall mortality of acute intestinal obstruction and to explore reasonable conservative treatment time before surgical treatment. Methods: A retrospective analysis of the hospitalized patients from 1995 to 2002 in West China Hospital records, etiology and classification of various causes, and analysis of mortality and preoperative conservative treatment interval correlation. Results: A total of 705 cases of acute intestinal obstruction were enrolled, of which 71.1% were in the small intestine and 82.6% were simple intestinal obstruction. The most common causes were adhesions (62.0%) and tumors (23.7%). 56.7% of cases received surgical treatment. The overall case fatality rate was 1.6%, with 1.3% in the conservative arm and 1.7% in the surgical arm. The incidence of intestinal necrosis increased with prolonged conservative treatment, which may occur when the strangulation occurs more than 24 h. CONCLUSIONS: Similar to the West, there is also an epidemiological trend in China of pathogenic to adhesive transfer. Based on the experience of West China Hospital of Sichuan University, nearly half of cases of simple intestinal obstruction can be treated conservatively. Conservative treatment extended lengthening and no trend of simple intestinal obstruction, or stranding occurred within 24 hours of the first case should be treated surgically.