口服泛影葡胺治疗粘连性不全性小肠梗阻的前瞻性研究

粘连性不全性小肠梗阻（ＡｄｈｅｎｓｉｖｅＰａｒｔｉａｌＳｍａｌＢｏｗｅｌＯｂｓｔｒｕｃｔｉｏｎ，ＡＰＳＢＯ）根据病史症状及放射学检查多能确诊，部分病人保守治疗有效。本文前瞻性评价泛影葡胺和甘露醇对粘连性不全性小肠梗阻的保守治疗作用及疗效。一、临床资...     

经口泛影葡胺对粘连性小肠不全梗阻疗效的前瞻性研究

目的 探讨泛影葡胺在急性粘连性小肠不全性梗阻的治疗使用,并与甘露醇与常规的保守治疗方法作前瞻性研究。方法 对１０９例急性粘连性小肠不全梗阻１１７例进行分析,随机将病人分成泛影葡胺组３７例经胃管注入７６％泛影葡胺溶液１００ｍｌ,甘露醇组３５例３６次经胃管注入１０％甘露醇溶液２００ｍｌ对照组３７例４０次一般保守治疗。     

泛影葡胺在诊治粘连性小肠梗阻中的临床应用

目的分析泛影葡胺在粘连性小肠梗阻的诊断和治疗中的作用。方法对本院484例粘连性小肠梗阻患者经口服或胃管注入76%泛影葡胺行胃肠道造影,对小肠梗阻进一步诊治的临床经过进行回顾性分析,并加以总结。结果484例患者中362例经应用泛影葡胺非手术治愈,122例经泛影葡胺造影明确诊断后根据具体情况实施手术治疗。结论泛影葡胺可用于诊断小肠梗阻并明确梗阻部位;可作为粘连性小肠梗阻非手术治疗常规措施并可重复使用;可为手术提供客观依据,对手术时机和切口选择有很好的指导作用。     

早期鼻饲泛影葡胺对粘连性肠梗阻诊治价值的临床研究

目的 探讨早期鼻饲泛影葡胺对粘连性肠梗阻的诊断及治疗效果.方法 对95例临床及x线检查确诊之粘连性肠梗阻患者被为分研究组与对照组.48例经胃管注入76%复方泛影葡胺80 ml为研究组,同时设无需胃管注人造影剂为空白对照组47例进行比较.结果 研究组中40例造影剂在6～24 h内到达结肠而 给予保守治疗,平均症状缓解时间为16±2.5 h,1～5 d(平均2.8 d)后症状消失;另8例见造影剂未进入结肠且症状体征加重选择及时剖腹手术治疗.对照组手术治疗16例,7例出现绞窄性肠梗阻.中转手术率及绞窄性肠梗阻发生率两组比较(16.67% vs 34.04%;2.08%v8 14.89%)均有显著性差异(P<0.05).结论 复方泛影葡胺应用于胃肠道造影对明确粘连性肠梗阻的梗阻部位及合理选择手术时机有很好的指导作用,早期鼻饲泛影葡胺有助于肠梗阻的缓解.     

泛影葡胺胃肠道造影在粘连性肠梗阻中的临床应用

目的 观察泛影葡胺在粘连性肠梗阻中的诊断及治疗效果和手术时机的选择。方法 对137例粘连性肠梗阻患者经胃管注入76％泛影葡胺60～100ml行胃肠道造影，通过腹部X线摄片动态观察造影剂在胃肠道中的位置及通过情况，以确定梗阻部位以及梗阻是否完全，从而确定手术时机。结果 137例中103例造影剂在6～24h后到达结肠而给予保守治疗，平均症状缓解时间为14．8h，1～6d（平均3．3d）后症状消失。另34例见造影剂不能到达结肠且症状体征加重而行手术治疗，痊愈。结论 泛影葡胺胃肠道造影在对粘连性肠梗阻明确梗阻部位及手术时机的选择方面有很好的指导作用，可作为临床医师诊断与治疗粘连性肠梗阻的一种手段。     

善宁联合泛影葡胺在老年人粘连性小肠梗阻治疗中的应用

腹部手术后腹腔粘连所致粘连性小肠梗阻,约占肠梗阻总数的40%左右[1].今将善宁联合泛影葡胺用于老年人粘连性小肠梗阻35例治疗,结果报告如下.     

善宁联合泛影葡胺治疗老年人黏连性小肠梗阻

目的 探讨老年人黏连性小肠梗阻保守治疗安全有效方法。方法 67例老年黏连性小肠梗阻病人，随机分成A组35例，加用善宁0．1mg皮下注射q8h，并经胃管注入76％的泛影葡胺100ml；B组32例为对照组。结果 A组保守治疗成功者32例，B组26例；A组胃肠引流量少于B组；第一次排气排便时间短于B组；住院时间短于B组。A组3例，B组6例中转手术治疗；A组无死亡，未发生因保守治疗延误病情，B组一例因术后肺部感染加重而死亡。结论 善宁联合泛影葡胺治疗老年人黏连性小肠梗阻，安全有效，临床上可以推广。     

泛影葡胺治疗粘连性小肠不完全梗阻临床研究

目的探讨泛影葡胺治疗粘连性小肠不完全梗阻的疗效及方法。方法随机将120例粘连性小肠梗阻患者。分为泛影葡胺治疗组(62例)和传统保守治疗组(58例)。比较2组患者在症状缓解时间、排气排便时间、住院时间、费用和中转手术治疗率。结果泛影葡胺治疗组平均症状缓解时间、排气排便时间、住院时间均显著短于传统保守治疗组(P<0.05),中转手术治疗率低于传统治疗组(P<0.05),住院费用差异无统计学意义(P>0.05)。2组患者无死亡,未发现与泛影葡胺相关的并发症。结论泛影葡胺治疗粘连性小肠梗阻安全有效、简单易行、并发症少。有效缓解肠梗阻,缩短住院时间,减少患者中转手术治疗率。值得临床推广应用。     

Water-soluble contrast agent in adhesive small bowel obstruction: a systematic review and meta-analysis of diagnostic and therapeutic value

Background

Adhesive small bowel obstructions are the most common postoperative causes of hospitalization. Several studies investigated the diagnostic and therapeutic role of water-soluble contrast agent (WSCA) in predicting the need for surgery, but there is no consensus.

Methods

A systematic review and meta-analysis was done of studies on diagnostic and therapeutic role of oral WSCA.

Results

WSCA had a sensitivity of 92% and a specificity of 93% in predicting resolution of obstruction without surgery; diagnostic accuracy increased significantly if abdominal X-rays were taken after 8 hours. The administration of oral WSCA reduced the need for surgery (odds ratio .55, P = .003), length of stay (weighted mean difference −2.18 days, P < .00001), and time to resolution (weighted mean difference −28.25 hours, P < .00001). No differences in terms of morbidity or mortality were recorded.

Conclusions

The administration of WSCA is accurate in predicting the need for surgery; the test should be taken after at least 8 hours from administration. WSCA is a proven safe and effective treatment, correlated with a significant reduction in the need for surgery and in the length of hospital stay.     

Therapeutic value of sesame oil in the treatment of adhesive small bowel obstruction

Background

The optimal treatment of partial adhesive small bowel obstruction (SBO) is still controversial. The purpose of this study was to determine the effects of oral administration of sesame oil to the standard of conservative treatment in this disease.

Methods

Sixty-four cases of partial adhesive SBO were retrospectively allocated into either the control group or the intervention group (with sesame oil added), and clinical results were compared.

Results

Of the 64 patients, 33 were in the control group and 31 in the intervention group. Significantly fewer patients required surgical intervention in the intervention group than in the control group (4/31 vs 16/33, P = .0029). Less SBO resolution time (24 hour vs 30 hour, P = .0019) and a shorter hospital stay (6 days vs 10 days, P = .0235) were observed in the interventional group.

Conclusions

Our study showed that sesame oil was a safe and effective adjunct to the standard treatment of partial adhesive SBO.     

Randomized controlled trial of Gastrografin in adhesive small bowel obstruction

BACKGROUND: Several previous studies have shown that Gastrografin can be utilized to triage patients with adhesive small bowel obstruction (ASBO) to an operative or a non-operative course. Previous studies assessing the therapeutic effect of Gastrografin have been confounded by post-administration radiology alerting the physician to the treatment group of the patient. Therefore the aim of the present paper was to test the hypothesis that Gastrografin hastens the non-operative resolution of (ASBO). METHODS: Patients, diagnosed with ASBO on clinical and radiological grounds, were randomized to receive Gastrografin or placebo in a double-blinded fashion. Patients did not undergo further radiological investigation. If the patient required subsequent radiological intervention or surgical intervention they were excluded from the study. End-points were passage of time to resolution of ASBO (flatus and bowel motion), length of hospital stay and complications. RESULTS: Forty-five patients with ASBO were randomized to receive either Gastrografin or placebo. Two patients were excluded due to protocol violations. Four patients in each group required surgery. Eighteen of the remaining patients received Gastrografin and 17 received placebo. Patients who received Gastrografin had complete resolution of their ASBO significantly earlier than placebo patients (12 vs 21 h, P = 0.009) and this translated into a median of a 1-day saving in time in hospital (3 vs 4 days, P = 0.03). CONCLUSIONS: Gastrografin accelerates resolution of ASBO by a specific therapeutic effect.     

Implementation of an adhesive small bowel obstruction protocol using low-osmolar water soluble contrast and the impact on patient outcomes

Background

Small bowel obstruction (SBO) is a common condition leading to numerous hospital admissions and operations. Standardized care of adhesive SBO patients has not been widely implemented in hospital systems.

Evaluation of a water-soluble contrast protocol for nonoperative management of pediatric adhesive small bowel obstruction

Background/purpose

We examined outcomes before and after implementing an enteral water-soluble contrast protocol for management of pediatric adhesive small bowel obstruction (ASBO).

Successful use of water-soluble contrast in patients with small bowel obstruction and virgin abdomen: A case report

Introduction and importanceNonoperative management of adhesive SBO is well established but remains a challenge in patients without prior abdominal surgery. We aim to report a case of successful nonoperative management with the use of enteral hypertonic water-soluble contrast administration in a patient with virgin abdomen.Case presentationA healthy 24-year old man with no previous surgery presented to the emergency room with one day of abdominal pain. A CT abdomen and pelvis was consistent with SBO without clear anatomic etiology. The patient refused surgical intervention, so we performed a trial of nonoperative management. On hospital day 2, a repeat CT A/P with enterally administered water-soluble contrast showed resolution of SBO. The patient has had no symptoms since hospital discharge on 6 months follow up.Clinical discussionSmall bowel obstruction is most commonly secondary to adhesions from prior surgeries.Even in patients with virgin abdomen, adhesions are the cause of SBO in 53%–73%.Recent studies in patients with virgin abdomen showed that 92.1% that underwent nonoperative management did not have a recurrence of SBO with mean follow up of 4.5 years. The use of water-soluble contrast in patients with virgin abdomen was reported to have 92–97% success rate.A meta-analysis showed a pooled prevalence of 7.7% of malignant etiology of SBO in these patients, more common with previous SBO admission or history of malignancy.ConclusionNonoperative management with the therapeutic use of hypertonic water-soluble contrast is a viable treatment option in select cases and avoids the morbidity of surgical exploration.     

Single-port laparoscopic treatment of small bowel obstruction

Background

The aim of this study was to report our initial experience with single-port laparoscopic surgery (SPLS) for small bowel obstruction (SBO).

Methods

Between October 2009 and April 2013, 36 patients underwent SPLS for SBO. SPLS was performed transumbilically. Patient demographics and operative and postoperative outcomes were analyzed.

Results

SPLS for SBO was successful in 35 patients. In 1 patient, a conversion to laparotomy was required. The median incision length, operative time, and postoperative length of stay were 2.3 cm (range, 1.5 to 5.0 cm), 115 min (range, 30 to 250 min), and 8 days (range, 3 to 26 days), respectively. The median time to resume oral intake was 3 days (range, 1 to 16 days). The intra- and postoperative complication rates were 6% and 11%, respectively.

Conclusion

SPLS was a safe and feasible therapeutic approach for SBO and may also be an excellent diagnostic tool when performed by an experienced SPLS surgeon in selected patients.