Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment - A prospective randomized trial
Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment - A prospective randomized trial
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DOI：
10.1097/00000658-200207000-00002
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发表时间：
2002-07-01
影响因子：
9
通讯作者：
Law, WL
中科院分区：
文献类型：
--
作者：
Choi, HK;Chu, KW;Law, WL
目的评价胃grafin在保守治疗不成功的粘连性小肠梗阻中的治疗价值。背景资料astrografin是一种高渗透性水溶性造影剂。除了预测手术需要外，这种造影剂在粘连性小肠梗阻中可能也有治疗作用。方法对有粘连性小肠梗阻临床证据的患者，除怀疑有绞窄外，均给予保守治疗。在最初48小时内有反应的患者继续保守治疗。在最初的48小时内没有临床和放射学改善的患者被随机分配接受胃grafin餐和随访研究或手术。对比剂在24小时内出现在大肠内视为部分梗阻，继续保守治疗。造影剂未能在24小时内到达大肠的患者考虑完全性梗阻，开腹手术，对于保守治疗超过48小时的患者，无论是否使用胃grafin，如果没有持续改善，则进行手术。结果共纳入124例粘连性梗阻139次。三名病人因怀疑肠绞窄入院后不久接受手术。两例患者确认为绞窄性梗阻。101例梗阻性发作在最初的48小时内有所改善，并继续进行保守治疗。只有1例患者在保守治疗6天后需要手术治疗。35例患者在48小时内无好转。19例患者随机接受胃grafin膳食和随访研究，16例患者接受手术治疗。胃grafin检查显示14例患者部分梗阻。所有患者的梗阻均在平均41小时后消失。其他5例患者因造影显示完全梗阻而行剖腹手术。胃grafin的使用显著减少了74%的手术需求。没有任何并发症可归因于胃grafin的使用。两组均未发生肠绞窄。结论应用胃grafin治疗粘连性小肠梗阻是安全的，保守治疗失败时可减少手术的需要。
ObjectiveTo assess the therapeutic value of Gastrografin in the management of adhesive small bowel obstruction after unsuccessful conservative treatment.Summary Background DataGastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need for surgery, there is probably a therapeutic role of this contrast medium in adhesive small bowel obstruction.MethodsPatients with clinical evidence of adhesive small bowel obstruction were given trial conservative treatment unless there was suspicion of strangulation. Those who responded in the initial 48 hours had conservative treatment continued. Patients showing no clinical and radiologic improvement in the initial 48 hours were randomized to undergo either Gastrografin meal and follow-through study or surgery. Contrast that appeared in the large bowel within 24 hours was regarded as a partial obstruction, and conservative treatment was continued. Patients in whom contrast failed to reach the large bowel within 24 hours were considered to have complete obstruction, and laparotomy was performed, For patients who had conservative treatment for more than 48 hours with or without Gastrografin, surgery was performed when there was no continuing improvement.ResultsOne hundred twenty-four patients with a total of 139 episodes of adhesive obstruction were included. Three patients underwent surgery soon after admission for suspected bowel strangulation. Strangulating obstruction was confirmed in two patients. One hundred one obstructive episodes showed improvement in the initial 48 hours and conservative treatment was continued. Only one patient required surgical treatment subsequently after conservative treatment for 6 days. Thirty-five patients showed no improvement within 48 hours. Nineteen patients were randomized to undergo Gastrografin meal and follow-through study and 16 patients to surgery. Gastrografin study revealed partial obstruction in 14 patients. Obstruction resolved subsequently in all of them after a mean of 41 hours. The other five patients underwent laparotomy because the contrast study showed complete obstruction. The use of Gastrografin significantly reduced the need for surgery by 74%. There was no complication that could be attributed to the use of Gastrografin. No strangulation of bowel occurred in either group.ConclusionsThe use of Gastrografin in adhesive small bowel obstruction is safe and reduces the need for surgery when conservative treatment fails.