The Value Of Without Previous Abdominal Surgical History In Predicting The Necessity Of Surgery In Patients With Small Bowel Obstruction

Object: To explore the value of no previous abdominal surgical history in predicting the necessity of surgical prucedure in patients with small bowel obstruction(SBO).Method: The clinical data of 277 patients who suffered from SBO in the Affiliated Hospital of Qingdao University from January 2013 to May 2014 were analyzed retrospectively. The patients were divided into two groups according to the previous abdominal surgical history: group A(patients having the history of previous abdominal surgery) and group B(patients without the history of previous abdominal surgery). The clinical parameters were compared including gender, age, etiology, and the data of laboratory test. A logistic regression model was established to predicting the necessity of surgical laparotomy in patients with SBO using the statistically significant parameters including without previous abdominal surgical history..Result: 143 male patients(51.6%) and 134 female patients(48.4%) were involved and studied, whose average age were 62.94±15.78 years old, and which average length of hospital stay was 11.24±6.65 days. 153 cases of patients(55.2%) had the history of previous abdominal surgery, and 124 cases of patients(44.8%) had no the history of previous abdominal surgery. 85 cases of 153 patients(55.56%) in group A underwent surgical procedure and 97 cases of 124 patients(78.22%) in group B underwent laparotomy. There was statistically significant difference between two groups(P=0.000). The level of blood urea nitrogen(BUN) and creatinine in group A were higher than that in group B, and the difference was statistically significant(P=0.048, P=0.001, respectively). 70 cases of 153 patients(45.75%) in group A had the past medical history of malignancy, none of 124 patients in group B had the history of malignancy, and the difference was statistically significant(P=0.000).Hyperactive bowel sounds occurred in 24 cases(15.69%) in group A, 7 cases(5.64%) in group B, and the difference was statistically significant(P=0.008).The logistic regression model was established:P=1/[1+e^(1.021-0.175* length of hospital stay+1.153* fever-1.120* without abdominal surgical history+0.643* Hypoactive bowel sounds)]. The accuracy,sensitivity and specificity of the logistic regression model were 76.5%, 86.3% and57.9% respectively.Conclusion: Adhesion is the most causes of SBO in the patients with previous abdominal surgical history, and most of which might be cured by conservative management. However, the cases without previous abdominal surgical history might have complicated etiology, and most of which might be treated by surgical procedure.In the clinical process of diagnosis and treatment of SBO, we should consider the history of previous abdmonial surgery, and choose the reasonable treatment strategy,avoiding delayed surgery, relieving the pain of patients and deceasing the length of hospital stay and hospital costs.