背景:手术探查肠梗阻的决定和时机取决于症状的临床表现和可能的病因。肠梗阻患者常有腹内高压(IAH),这与预后不良有关。
目的:本研究的目的是评估与腹内压(IAP)相关的肠梗阻患者的手术效果。
方法:本研究对50例肠梗阻患者进行手术治疗。术前,在所有患者中测量IAP,并根据是否存在IAP分为两组。评估患者的术后住院时间或ICU住院时间,手术部位感染,伤口裂开,和手术后的恢复。
结果:术前IAH患者术后住院时间明显延长,这些患者的中位住院时间为8天,而非IAH患者的中位住院时间为4天(p=0.009)。在与IAP升高相关的组中,肠壁坏疽改变(p=0.042)和筋膜裂开(p=0.018)的患者数量显着增加(24%)。需要呼吸机支持的患者中,共有75%属于提高的IAP组。入住ICU的患者的平均IAP明显高于未入住ICU的患者(p=0.027)。
结论:肠梗阻的术前IAH是预测肠缺血伴坏疽可能性的重要因素,穿孔,腹内脓毒症,手术部位感染,并延长住院时间。在这种情况下,必须考虑早期手术探查和腹部减压。
BACKGROUND: The decision and timing of surgical exploration of intestinal obstruction depend on the clinical findings and probable etiology of the symptoms. Patients with intestinal obstruction often have intra-abdominal hypertension (IAH), which is associated with a poor prognosis.
OBJECTIVE: The purpose of the study is to evaluate the surgical outcomes in patients with intestinal obstruction in relation to intra-abdominal pressure (IAP).
METHODS: The study was conducted on 50 patients with intestinal obstruction undergoing surgery. Preoperatively, IAP was measured in all the patients and was allocated into two groups based on the presence or absence of IAP. Patients were assessed for the postoperative length of hospital or ICU stay, surgical site infection, wound dehiscence, and recovery following surgery.
RESULTS: The patients with preoperative IAH had significantly longer postoperative stays, with a median stay of eight days in these patients compared to four days in patients without IAH (p=0.009). A significantly higher number of patients (24%) had gangrenous changes on the bowel wall (p=0.042) and fascial dehiscence (p=0.018) in the group associated with raised IAP. A total of 75% of patients who required ventilator support belonged to the raised IAP group. The mean IAP in patients admitted to the ICU was significantly higher than in patients not admitted to the ICU (p=0.027).
CONCLUSIONS: Preoperative IAH in intestinal obstruction is a significant factor in predicting the possibility of bowel ischemia with gangrene, perforation, intra-abdominal sepsis, surgical site infections, and prolonged hospital stay. Early surgical exploration and abdominal decompression must be considered in such cases.