| Background and Objective: Non-surgical treatment is the main treatment for postoperative Adhesive Small Bowel Obstruction(ASBO).Although the treatment can relieve the obstructive symptoms of most patients,because the intestinal adhesions cannot be relieved,the symptoms of intestinal obstruction may occur repeatedly,and the patients may actively control their diet in order to reduce the occurrence of obstruction,which can lead to a decrease in the quality of life of the patients.Nutritional risk is a problem that needs clinical attention.The research group formulated strict inclusion and exclusion criteria in the early stage to screen out patients with simple adhesions and recurrent postoperative ASBO,and perform Laparoscopic Adhesiolysis(LA)treatment in the non-acute period of obstruction.A small sample(n =20)The study achieved satisfactory results in a short period of time(6 months).This study intends to expand the sample size and extend the follow-up time to evaluate the clinical efficacy of LA in the treatment of recurrent postoperative ASBO.Methods:Collected the clinical data of patients undergoing LA treatment after recurrent ASBO in the Department of Gastrointestinal Surgery,Affiliated Hospital of Zun Yi Medical University from 2013.04 to 2020.04,meeting the inclusion and exclusion criteria formulated in the previous study:(1)For all patients included in the study:(1)Collect the patient’s gender,age,previous abdominal surgery methods and frequency,the number of hospitalizations due to adhesive intestinal obstruction,the types of intestinal adhesions(simple/complex adhesions)that were clear during LA operation,operation time,intraoperative blood loss,postoperative bowel Functional recovery time,postoperative hospital stay,etc.;(2)Collect the occurrence of surgical complications to evaluate the safety of the operation;(3)Compare the body mass index(BMI)and quality of life scores before and 1 month and 6 months after the operation to determine whether LA surgery can improve the nutritional status and quality of life of patients;(4)Collect the recurrence of intestinal obstruction during the follow-up period to evaluate the effectiveness of the operation;(2)The patients included in the study are divided into normal nutrition group and nutrition risk group according to whether there are nutritional risks,and compare the two groups of patients:(1)General information: gender,age,number of hospitalizations due to intestinal obstruction(2～3 times/≥4 times),previous abdominal surgery methods,adhesion types,operation time,intraoperative blood loss,postoperative bowel function recovery time,Postoperative hospital stay;(2)BMI and quality of life score before operation and 1 month and 6 months after operation.Results:(1)A total of 53 patients included in this study(1)The postoperative complication rate was 2%(1/53),which was the encapsulated fluid in the abdominal cavity after the operation,and no other operative complications occurred;(2)BMI at 1 and 6 months after operation was significantly higher than that before operation(all p<0.05);BMI at 1 and 6 months after operation did not change significantly(p>0.05);the quality of life scores at 6 months after operation All were higher than before operation(p<0.05);(3)The median follow-up time was 33(6～84)months,and there was no recurrence of intestinal obstruction in 53 patients during the follow-up period;(2)There were 23 cases in the normal nutrition group and 30 cases in the nutrition risk group.Comparison of the two groups of patients:(1)There was no statistical difference between the two groups of patients in terms of gender,age,and composition of previous abdominal surgery methods(all P>0.05);(2)Comparing hospitalizations for 2～3 times and ≥4 times due to obstructive episodes,the proportions of the normal nutrition group were 87%(20/23)and 13%(3/23),respectively,and the nutrition risk group accounted for 83%(25/ 30)and 17%(5/30),the difference between the two groups was statistically significant(p<0.05),suggesting that repeated episodes of multiple hospitalizations are a factor leading to the nutritional risk of patients;(3)There was no statistically significant difference in operation time and intraoperative blood loss between the two groups(all P>0.05),and the types of adhesions confirmed during the operation were simple adhesions;the postoperative intestinal function recovery time and postoperative hospital stay were not statistically significant Differences(all P>0.05),suggesting that multiple episodes of hospitalization did not increase the difficulty of the operation and affect the patient’s postoperative recovery;(4)In the nutrition risk group,the BMI in the first and sixth months after the operation was significantly higher than that before the operation(p<0.05),and the quality of life scores in the six months after the operation were significantly improved compared with that before the operation(p<0.05),but in the first and six months after the operation BMI did not change significantly(p>0.05);the scores of BMI at 1 and 6 months after surgery and quality of life at 6 months after surgery in the normal nutrition group were all higher than those before surgery,but the differences were not statistically significant(all p>0.05),Suggesting that LA surgery mainly improves the nutritional status and quality of life of patients in the nutritional risk group.conclusion:(1)For patients with recurrent postoperative adhesive incomplete intestinal obstruction of simple adhesion type,LA surgery in the non-acute attack stage can effectively relieve adhesions,avoid recurrence of obstruction,improve the nutritional status of patients,and improve the lives of patients Quality,long-term effect is satisfactory;(2)Repeated episodes of multiple hospitalizations are a factor leading to nutritional risk in ASBO patients after surgery.LA surgery can significantly improve the nutritional status and quality of life of such patients. |
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