Clinical Research On The Scheme Of Combined Treatment Of Integrated Traditional Chinese And Western Medicine And Minimally Invasive Surgery In Acute Adhesive Intestinal Obstruction In Three Stages

ObjectiveTo establish a scheme,in which the integrated traditional Chinese and westemmedicine,laparoscopic surgery,as well as herbal medicine are carried out by threestages in the treatment of acute adhesive intestinal obstruction,and to evaluate thefeasibility,effectiveness and superiority of the scheme comparing with other schemes,and to determine the risk factors of non-operation,laparoscopic adhesiolysis,thepostoperative intraperitoneal adhesion formation,recurrence after treatmentsrespectively,so as to provide foundations to select the type of treatment.MethodsThe process of the scheme are,in the acute phase,the cases which were initiallyconservative managed with integrated traditional Chinese and western medicine toresolve the obstruction;in the remission phase,re-scheduled laparoscopicadhesiolysis was attempt to resolve the causes of the obstruction;in the phase ofconsolidating effectiveness,herb medicine was used to promote the return of bowelfunction,that will reduce the formation of postoperative adhesions to avoidrecurrence of intestinal obstruction.From January 2003 to March 2008,225 patients suffering from acute adhesiveintestinal obstruction were randomized into five groups:combined treatmentgroup(CTG),integrated traditional Chinese and western medicine non-operationgroup(CWnG),western medicine non-operation group(WnG),open surgerygroup(OSG)and emergency laparoscopic group(ELG),each group of 45 patients.Each group was treated according to the scheme respectively;each case wasfollowed-up more than one year.In the acute phase,the outcomes of conservativetreatment with integrated traditional Chinese and western medicine were comparedwith that of westem medicine non-operation treatment.In the remission phase,theoutcomes were compared between re-scheduled laparoscopic surgery andre-scheduled open surgery as well as re-scheduled and.emergency laparoscopicsurgery.The recurrence of each group was compared,too. There are 197 cases in which the cause of obstruction is postoperativeintraperitoneal adhesions.Data collected included their relative information,type ofmanagement,and outcomes of treatment and we determined the risk factors ofsurgical intervention of conservative management,conversion to laparotomy andintra-operation morbidity of laparoscopic surgery,severe degree intraperitonealadhesions,and recurrence after treatment.ResultsPatients in CTG,CWnG and OSG were conservative managed with integratedtraditional Chinese and western medicine in acute phase and the successful rate ofnon-operation was 93.3%(42/45),91.1%(41/45),93.3%(42/45)in each grouprespectively,statistically significantly higher than that of WnG (73.3%,33/45)inwhich patients were conservative managed with western medicine.The time ofresolving obstruction in CTG was 19.21 hours,CWnG 18.27 hours,OSG 19.95 hours,significantly shorter than that of WnG (28.76 hours).In the remission phase,the rateof intraoperative complications in CTG were 9.5% (4/42)is similar with OSG (7.1%,3/45).In CTG the operation time was 65.41 minutes,postoperative complicationswere 5.1% (2/39),time to first bowel movement was 46.49 hours,and the length ofpostoperative hospital stay was 4.18 days,significantly superior than that in OSG,73.50 minutes,21.4% (9/42),88.83 hours,8.19 days.CTG compared with ELG,thefrequency oflaparotomic conversion was 7.1% (3/42)vs.37.7% (17/45),the rate ofintraoperative complication was 9.5% (4/42)vs.33.3% (15/45),median operationtime was 65.41 vs.112.43 minutes,the rate of postoperative complications was 5.1%(2/39)vs.25% (7/28),the time to first bowel movement was 46.49 vs.54.68 hours,the length of postoperative hospital stay was 4.18 vs.4.61 days,the outcomes in CTGwere superior than those in ELG.Through a long-term follow-up,the recurrence ratein CTG was 5.1% (2/39),significantly lower than that in CWnG (29.3%,12/41),OSG (21.4%,9/42)and WnG (33.3%,11/33)respectively,and no significantlydifferences were found with ELG (14.3%,4/28).The time of interval between aftertreatment and recurrence in CTG was 28.5 months,significantly longer than that inCWnG (9 months),OSG (12 months),WnG (9 months),and similar with ELG (27 months).The risk factors of surgical intervention of conservative management are agelower than 60 years and previous emergency surgery.The conservative treatment ofthe integrated traditional Chinese and western medicine were the protection factors,compared with westem medicine non-operative management,significantly reducedthe conversion rate.More episodes of acute small bowel obstruction (ASBO)was therisk factors of conversion to laparotomy.The re-scheduled laparoscopic treatment wasthe protective factor of conversion to laparotomy and intraoperative complications,which could avoid those compared with emergency laparoscopic surgery.Severeintraperitoneal adhesions was relative with the number of previous operations,moreprevious abdominal operations was the risk factor of severe adhesions.More episodesof ASBO and more previous abdominal operations were the risk factors of recurrence.Open surgery and non-operative management were the risk factors of recurrence,while laparoscopic surgery maybe avoid recurrence.Conclusion1.In acute phase,the scheme of"combined treatment of integrated traditionalChinese and western medicine and minimally invasive surgery in acute adhesiveintestinal obstruction in three stages"adopts conservative management of integratedtraditional Chinese and westem medicine to resolve the obstruction and avoidemergency operation;in the remission phase,re-scheduled laparoscopic adhesiolysiswas attempt to resolve the causes of the obstruction and avoid recurrence.Combinedtreatment of integrated traditional Chinese and western medicine and minimallyinvasive surgery play to their strengths,and meet the shortfall,and weight over asingle treatment.2.In acute phase,the outcome of conservative treatment of integratedtraditional Chinese and western medicine is superior to that of western medicinenon-operation,and is the protective factor to avoid surgical conversion.In theremission phase,re-scheduled laparoscopic lysis,has the superior of minimallyinvasive.re-scheduled laparoscopic surgery is safer and more effective thanemergency laparoscopic surgery,and is the protective factor to avoid conversion to laparotomy and intraoperative complications.The laparoscopic surgery will reducethe recurrence of adhesive intestinal obstruction.