Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery.
Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery.
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DOI：
10.1186/1749-7922-6-5
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发表时间：
2011-01-21
期刊：
影响因子：
--
通讯作者：
Jeekel J
中科院分区：
文献类型：
--
作者：
Catena F;Di Saverio S;Kelly MD;Biffl WL;Ansaloni L;Mandalà V;Velmahos GC;Sartelli M;Tugnoli G;Lupo M;Mandalà S;Pinna AD;Sugarbaker PH;Van Goor H;Moore EE;Jeekel J
目前对ASBO的诊断和治疗尚无共识。最初的保守治疗通常是安全的，但适当的时间停止非手术治疗仍然是有争议的。开放手术或腹腔镜手术在没有标准化适应症的情况下使用。2010年7月1日至3日，在博洛尼亚举行的第一届世界急诊外科学会国际大会和第九届腹膜和外科学会会议期间，一个由1 - 3名对ASBO和腹膜疾病感兴趣和有背景的国际专家组成的小组参加了一次共识会议，为ASBO的诊断和管理制定循证建议。每当缺乏高级别证据时，工作组就通过取得共识来制定准则。在没有绞窄体征和持续呕吐史或合并CT扫描体征（游离液体、肠系膜水肿、小肠粪便体征、肠血管离断）的情况下，部分ASBO患者可以使用NOM安全管理，并应尝试插管减压（长管或NG）。这些患者是诊断和治疗目的的水溶性造影剂（WSCM）的良好候选者。在给药后24小时内，X线检查显示结肠中出现水溶性造影剂，可预测其消退。WSCM可在入院时立即或在最初尝试保守治疗48小时后口服或通过NGT（50-150 ml）给药。使用WSCM治疗ASBO是安全的，并减少了手术需求，解决时间和住院时间。NOM在没有绞窄或腹膜炎迹象的情况下，可延长至72小时。NOM 72小时后，建议进行手术。非手术治疗的患者住院时间较短，但复发率较高，再次入院的时间较短，尽管新的ASBO手术治疗发作的风险没有改变。复发的危险因素是年龄<40岁和粘连粘连。与传统保守治疗相比，WSCM不影响复发率或需要手术的复发率。开放手术是外科治疗绞窄性ASBO以及保守治疗失败后的首选方法。在选定的患者和适当的技能，腹腔镜方法可以尝试使用开放进入技术。左上象限应该是安全的。腹腔镜粘连松解术最好在SBO首次发作和/或预期的单条带的情况下尝试。应保持开放转换的低门槛。应预防腹膜粘连。羟乙磺酸-羧纤维素膜和艾考糊精可降低粘连发生率。艾考糊精可降低再梗阻的风险。医管局不能减少手术的需要。
There is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial. Open surgery or laparoscopy are used without standardized indications. A panel of 13 international experts with interest and background in ASBO and peritoneal diseases, participated in a consensus conference during the 1st International Congress of the World Society of Emergency Surgery and 9th Peritoneum and Surgery Society meeting, in Bologna, July 1-3, 2010, for developing evidence-based recommendations for diagnosis and management of ASBO. Whenever was a lack of high-level evidence, the working group formulated guidelines by obtaining consensus. In absence of signs of strangulation and history of persistent vomiting or combined CT scan signs (free fluid, mesenteric oedema, small bowel faeces sign, devascularized bowel) patients with partial ASBO can be managed safely with NOM and tube decompression (either with long or NG) should be attempted. These patients are good candidates for Water Soluble Contrast Medium (WSCM) with both diagnostic and therapeutic purposes. The appearance of water-soluble contrast in the colon on X-ray within 24 hours from administration predicts resolution. WSCM may be administered either orally or via NGT (50-150 ml) both immediately at admission or after an initial attempt of conservative treatment of 48 hours. The use of WSCM for ASBO is safe and reduces need for surgery, time to resolution and hospital stay. NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution surgery is recommended. Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions. WSCM does not affect recurrence rates or recurrences needing surgery when compared to traditional conservative treatment. Open surgery is the preferred method for surgical treatment of strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach can be attempted using open access technique. Access in the left upper quadrant should be safe. Laparoscopic adhesiolysis should be attempted preferably in case of first episode of SBO and/or anticipated single band. A low threshold for open conversion should be maintained. Peritoneal adhesions should be prevented. Hyaluronic acid-carboxycellulose membrane and icodextrin can reduce incidence of adhesions. Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery.
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影响因子：
2.5
作者：
Catena, Fausto;Ansaloni, Luca;Lauro, Augusto;Ercolani, Giorgio;D'Alessandro, Luigi;Pinna, Antonio
通讯作者：
Pinna, Antonio
影响因子：
14.6
作者：
Chen, SC;Yen, ZS;Chen, WJ
通讯作者：
Chen, WJ
影响因子：
4.3
作者：
Choi, Hok-Kwok;Law, Wai-Lun;Chu, Kin-Wah
通讯作者：
Chu, Kin-Wah
影响因子：
9
作者：
Choi, HK;Chu, KW;Law, WL
通讯作者：
Law, WL
影响因子：
9.6
作者：
Biondo, S;Parés, D;Jaurrieta, E
通讯作者：
Jaurrieta, E