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1、急性肠梗阻的病因学和病死率：705例回顾分析【摘要】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
2、过24h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24h内的病例应接受外科治疗。【关键词】肠梗阻病因学预后病死率Acuteintestinalobstructionisoneofthemostcommonsurgicalemergencies,whichinvolvesapartialorcompleteblockageofthebowelthatinducesmechanicalimpa
3、irmentorcompletearrestofthepassageofcontentsthroughtheintestine.23Theetiologyofacuteintestinalobstructionisvariousandcomplicated.Indifferentcountriesorareas,theetiologyofacuteintestinalobstructionisdiversetosomeextent.Whilethemostfrequentetiologicalfactorispostoperativeadhe
4、sionsindevelopedcountries,andstrangulatedherniasaremorecommonindevelopingcountries［1］.Moreover,atdifferenttimes,theetiologyhasalsochanged.Decadesago,theherniawasreportedasthefirstcauseoftheacuteintestinalobstruction［2］,butrecentreportsdemonstratedthatintraperitonealadhesion
5、becamethemostpossiblecauseofthisdisease［2,3］.InChina,thereseemedtobethesimilaretiologicaltransitiontrend［4］.Itiscommonsensethatmostofthepatientswithacuteintestinalobstructionrequiresurgicalinterventionduetothemechanicalnatureofthedisease.However,conservativetherapyisstillco
6、nsideredasaselectiveapproachtothemanagementofselectedpatients,suchasincompleteadhesiveobstruction.Aftereffectiveinterventionofgastrointestinaldecompression,fasting,prophylacticortherapeuticantibiotics,andnutritionsupport,partofthepatientswithacuteintestinalobstructionmighta
7、chievepalliationandavoidoperation.However,23conservativetherapymayincreasetherateofstrangulation,theriskofintestinalnecrosisandthemortality.Thepresentretrospectivereviewaimstofigureouttheetiologicalfactorsandoveralloutcomes,andtoexploretherationallengthoftimeforconservative
8、therapybeforeconversionofoperation.1Clinicaldataandmethods1.1PatientsThemedicalrec
