摘要
Abstract
Objective To compare the clinical efficacy of gastrointestinal decompression versus no decompression in the conservative management of older patients with adhesive small bowel obstruction(ASBO).Methods A retrospective cohort study was conducted,enrolling 305 older patients with ASBO admitted to the emergency surgery and general surgery departments of our hospital from January 2016 to December 2024.Based on the initial intervention,patients were divided into a non-decompression group(164 cases)and a decompression group(141 cases).Both groups received standard supportive care(including fasting,intravenous fluid resuscitation),while the decompression group underwent additional catheter-based gastrointestinal decompression.Propensity score matching(1︰1 ratio)was performed to balance baseline characteristics between the two groups.Primary outcomes included early feeding recovery within 3 days.Secondary outcomes encompassed the incidence of the actual time to dietary recovery,aspiration pneumonia,conversion to surgery and mortality.Results A total of 305 patients were included,178 males and 127 females,aged 71.0(65.0,78.0)year old.53.8%of patients(164/305)initially refused to accept gastrointestinal decompression treatment.After 1︰1 matching of the two baseline datasets,each group included 104 patients for analysis.The three-day feeding recovery rates in the decompression-free group and decompression group were 65.4%(68/104)vs 42.3%(44/104)(P=0.001),with actual feeding recovery times of 3.0(2.0,4.0)days versus 4.0(3.0,5.0)days(P=0.002).The overall feeding recovery rates were 100.0%(104/104)vs 99.0%(103/104).The incidence of aspiration-related pneumonia was 1.9%(2/104)vs 2.9%(3/104),with transfer surgery rates at 1.0%(1/104)vs 2.9%(3/104),and mortality rates at 0(0/104)vs 1.0%(1/104).No statistically significant differences were observed on the primary outcome and three secondary outcomes above(all P>0.05).For early intestinal obstruction recovery within 3 days,multivariate Cox regression analysis showed that no decompression therapy could promote dietary recovery earlier(HR=0.454,95%CI:0.299-0.689).Conclusions In the treatment of elderly patients with adhesive small bowel obstruction,the early goal of diet can be achieved without gastrointestinal decompression,and there is no increase in pneumonia,risk of death and risk of conversion to surgery.关键词
老年人/粘连性小肠梗阻/胃肠道减压/保守治疗Key words
Elderly/Adhesive small bowel obstruction/Gastrointestinal decompression/Conservative treatment
