Value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: A prospective evaluation
Value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: A prospective evaluation
复制标题
DOI：
10.3748/wjg.v11.i24.3742
复制
发表时间：
2005-06-28
影响因子：
4.3
通讯作者：
Chu, Kin-Wah
中科院分区：
文献类型：
--
作者：
Choi, Hok-Kwok;Law, Wai-Lun;Chu, Kin-Wah
目的：泛影葡胺是一种高渗水溶性造影剂。除了其对手术治疗需要的预测价值外，该药物在粘连性小肠梗阻中也具有潜在的治疗作用。本研究旨在评估泛影葡胺在保守治疗失败时治疗粘连性小肠梗阻的有效性。方法：粘连性小肠梗阻患者除非担心肠绞窄，否则接受尝试性保守治疗。那些在最初 48 小时内做出反应的人继续进行保守治疗。最初 48 小时内没有任何改善的患者通过鼻胃管给予 100 mL 泛影葡胺，然后进行连续腹部 X 光检查。 24小时内出现大肠造影者视为部分梗阻，继续保守治疗。造影剂在24小时内未能到达大肠的患者被认为完全梗阻并进行剖腹手术。结果：纳入了212名患者，共发生245次粘连性梗阻。 15 名患者因害怕被勒死而入院后不久就接受了手术。 186 次梗阻在最初 48 小时内有所改善，并继续保守治疗。两名患者因持续梗阻而接受后续手术。 44 次梗阻在 48 小时内未见改善，并给予泛影葡胺治疗。七名患者接受了完全梗阻手术。其他 37 例患者出现部分梗阻，除一名患者因持续性梗阻而需要剖腹手术外，其余所有病例均随后缓解。本研究的总体手术率为10%。没有出现可归因于使用泛影葡胺的并发症。结论：保守治疗不成功后，使用泛影葡胺治疗粘连性小肠梗阻是安全的，并且减少了手术干预的需要。 (C) 2005 The WJG Press 和 Elsevier Inc. 保留所有权利。
AIM: Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need for operative treatment, a potential therapeutic role of this agent in adhesive small bowel obstruction has been suggested. This study aimed at evaluating the effectiveness of gastrografin in adhesive small bowel obstruction when conservative treatment failed.METHODS: Patients with adhesive small bowel obstruction were given trial conservative treatment unless there was fear of bowel strangulation. Those responded in the initial 48 h had conservative treatment continued. Patients who showed no improvement in the initial 48 h were given 100 mL of gastrografin through nasogastric tube followed by serial abdominal radiographs. Patients with the contrast appeared in large bowel within 24 h were regarded as having partial obstruction and conservative treatment was continued. Patients in which the contrast failed to reach large bowel within 24 h were considered to have complete obstruction and laparotomy was performed.RESULTS: Two hundred and twelve patients with 245 episodes of adhesive obstruction were included. Fifteen patients were operated on soon after admission due to fear of strangulation. One hundred and eighty-six episodes of obstruction showed improvement in the initial 48 h and conservative treatment was continued. Two patients had subsequent operations because of persistent obstruction. Forty-four episodes of obstruction showed no improvement within 48 h and gastrografin was administered. Seven patients underwent complete obstruction surgery. Partial obstruction was demonstrated in 37 other cases, obstruction resolved subsequently in all of them except one patient who required laparotomy because of persistent obstruction. The overall operative rate in this study was 10%. There was no complication that could be attributed to the use of gastrografin.CONCLUSION: The use of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment is safe and reduces the need for surgical intervention. (C) 2005 The WJG Press and Elsevier Inc. All rights reserved.