Onoue Shigemi, Katoh Takehito, Shibata Yoshihisa, Matsuo Koji, Suzuki Masaomi, Chigira Haruhiko
Department of Surgery, Toyohashi Municipal Hospital, 50 Hachiken-nishi, Aotake-cho, Toyohashi, Aichi 441-8085, Japan.
Hepatogastroenterology. 2002 Nov-Dec;49(48):1576-8.
BACKGROUND/AIMS: Contrast radiology predicts the outcome of treatment for patients with small bowel obstruction. The optimal method of contrast radiology to determine the indications for and timing of surgery is controversial.
Contrast radiology was performed for patients with postoperative adhesive small bowel obstruction between April 1, 2000 and March 31, 2001. Nearly 40 mL of gastrografin mixed with 40 mL of water was administered either orally or via a nasogastric tube to each patient within 24 hours of hospital admission. Serial erect and supine plain abdominal radiographs were taken 4, 8, 16 and 24 hour later.
Of 107 patients with postoperative adhesive small bowel obstruction, 97 patients had the examination completed. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of this study as an indicator for non-operative treatment were 98.9%, 66.6%, 96.9%, 97.8% and 80%. However, contrast radiology had little impact on the diagnosis of 6 patients with strangulated small bowel obstruction. Ninety-two of 93 patients (98.9%) who were resolved with non-operative treatment were resolved within 48 hours of hospitalization.
Contrast radiology should be considered for patients with simple small bowel obstruction who did not improve with non-operative measures after 48 hours of hospitalization.
背景/目的：对比放射学可预测小肠梗阻患者的治疗结果。确定手术指征和时机的最佳对比放射学方法存在争议。
对2000年4月1日至2001年3月31日期间术后粘连性小肠梗阻患者进行对比放射学检查。在患者入院24小时内，经口服或通过鼻胃管给每位患者注入近40毫升泛影葡胺与40毫升水的混合液。分别于4、8、16和24小时后拍摄系列立位和平卧位腹部平片。
107例术后粘连性小肠梗阻患者中，97例完成了检查。本研究作为非手术治疗指标的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为98.9%、66.6%、96.9%、97.8%和80%。然而，对比放射学对6例绞窄性小肠梗阻患者的诊断影响不大。93例经非手术治疗缓解的患者中，92例（98.9%）在住院48小时内缓解。
对于住院48小时后非手术治疗无改善的单纯性小肠梗阻患者，应考虑进行对比放射学检查。
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