Objective :To investigate the incidence ,predisposing factors and therapeutic modalities of acute colonic pseudo-obstruction (ACPO) in patients after total hip arthroplasties (THA) and total knee arthroplasties (TKA). Methods:From January 2006 to December 2009,12 patients with ACPO after THA and TKA operation were investigated retrospectively, who were viewed as the ACPO group. There were 10 males and 2 females with an average age of (78±12) years in the ACPO group.Other 853 patients without ACPO after THA and TKA operation were viewed as the control group treated at the same period.The incidence of ACPO was calculated. The clinical data were collected and compared between the two groups including patient age, gender, procedure, anesthetic class, clinical presentation, radiographic findings, duration from index surgery to diagnosis of ACPO,treatment,postoperative mobilization time ,and length of hospital stay. Results:The incidence of ACPO was 1.4％. The incidence of primary THA (1.3％) was higher than that of primary TKA (0.4％) ;the incidence of hip and knee revisions (5.0％) was higher than that of primary THA and TKA (1.0％); there was no difference in incidence between hip revisions (5.5％) and knee revisions (4.0％). The mean age was (78±12) years old in ACPO group and (71±13) in the control group. The male/female ratio was 5:1 in ACPO group and 2:3 in control group. There were statistical differences in mean age and gender ratio between the two groups. No association was found with respect to anesthetic class. On average ,ACPO occurred at 2.5 days after index surgery. The abdominal distention occurred in all 12 cases, nausea or vomiting in 8 cases and abdominal pain in 3 cases. Radiographically cecal dilation occurred in all cases and intestinal dilation in 3 cases. All patients initially were treated conservatively with immediate cessation of oral intake, a nasogastric tube and oral mineral oil. Three patients received a rectal tube. Only 1 patient required endoscopic decompression. There were no deaths after ACPO in the series. Mean mobilization time after surgery averaged (5.0±2.2) days in ACPO group compared with (2.5±1.1) days in the control group.Mean hospital stay averaged (16.5±6.4)days in ACPO group compared with (10.5±4.5) days in the control group. There were statistical differences in mean mobilization time after surgery and mean hospital stay between two groups. Conclusion:ACPO mainly happened in old male patients. The majority cases response to conservative treatment and their prognoses are good. But ACPO will delay mobilization time after surgery and increase hospital stay.%目的:分析人工全髋膝置换术后发生急性结肠假性梗阻(ACPO)的发生率、危险因素及治疗方法.方法:以回顾性研究方法对2006年1月至2009年12月在我院行人工全髋膝置换术后发生的12例ACPO病例(ACPO组),与同期行人工全髋膝置换术的853例(对照组)比较.统计分析ACPO的发生率,分析2组间年龄、性别、手术类型、麻醉ASA分级、临床表现、放射学征象、发生时间、治疗方法、术后下床时间及住院天数.结果:ACPO总的发生率为1.4%,初次全髋置换术ACPO的发生率(1.3%)高于初次全膝置换术(0.4%),翻修手术(5.0%)高于初次置换手术(1.0%),全髋翻修术(5.5%)与全膝翻修术(4.0%)ACPO的发生率比较差异无统计学意义.ACPO组的平均年龄为(78±12岁,对照组为(71±13)岁;ACPO组男女之比为5:1,而对照组的男女之比为2:3,差异均有统计学意义.ASA分级在2组间差异无统计学意义.ACPO平均发生时间为术后2.5 d,12例均有腹胀,8例有恶心或呕吐,3例有腹痛;放射学上均有结肠扩张,3例有小肠扩张.治疗上所有患者给予禁食、胃肠减压及口服石蜡油,3例给予肛管排气,1例严重患者行结肠镜辅助下肠道减压,无死亡病例.ACPO组平均下床时间为(5.0±2.2)d,对照组为(2.5±1.1)d;ACPO组平均住院时间为(16.5±6.4)d,对照组为(10.5±4.5)d,差异均有统计学意义.结论:ACPO好发于老年男性,绝大多数病例保守治疗有效,预后较好,但会延长术后的下床时间及住院时间.
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