Otterson Mary F, Lundeen Sarah J, Spinelli Kristine S, Sudakoff Gary S, Telford Gordon L, Hatoum Ossama A, Saeian Kia, Yun Hyun, Binion David G
Department of Surgery, Medical College of Winsconsin, Milwaukee 53226, USA.
Surgery. 2004 Oct;136(4):854-60. doi: 10.1016/j.surg.2004.06.023.
The purpose of this study was to determine the accuracy of barium radiography compared with intraoperative evaluation with passage of a balloon catheter for assessment of stricturing Crohn's disease (CD).
After institutional review board approval, we retrospectively reviewed a tertiary inflammatory bowel disease center's consecutive records of surgical patients between 1998 and 2003 with small intestinal CD to compare the number of strictures found at surgery with those identified preoperatively by barium imaging. Age, gender, prior surgical procedures, and steroid usage were recorded. By decision of the surgeons, all patients were treated with an identical approach that utilized intraluminal sizing with passage of a balloon-tipped catheter.
In 118 patients, 230 strictures were identified by barium examination; 365 strictures were identified using the balloon catheter technique. Barium examination overestimated or underestimated the number of strictures in 43 of 118 patients (36%). Overall, barium radiography was least accurate in patients with strictures amenable to strictureplasty. Prior surgery and multiple strictures identified preoperatively by barium studies were found to decrease the accuracy of the barium examination, but the decrease did not reach statistical significance. After successful surgery for stricturing small intestinal CD, more than 90% of patients can successfully be weaned from their steroids within 3 months. Failure to be able to wean from steroids may suggest a missed stricture.
Our data suggest that careful exploration and intraoperative, intraluminal testing of intestinal patency identify additional strictures compared with barium radiographs in a significant number of patients with CD undergoing small bowel surgical intervention.
本研究的目的是确定与术中通过球囊导管评估相比，钡剂造影在评估克罗恩病（CD）狭窄方面的准确性。
经机构审查委员会批准后，我们回顾性分析了一家三级炎症性肠病中心1998年至2003年连续的手术患者记录，这些患者患有小肠CD，以比较手术中发现的狭窄数量与术前钡剂成像确定的狭窄数量。记录年龄、性别、既往手术史和类固醇使用情况。根据外科医生的决定，所有患者均采用相同的方法治疗，即通过带气囊导管的腔内测量。
118例患者中，钡剂检查发现230处狭窄；使用球囊导管技术发现365处狭窄。钡剂检查高估或低估了118例患者中43例（36%）的狭窄数量。总体而言，钡剂造影在适合行狭窄成形术的狭窄患者中准确性最低。发现既往手术史和术前钡剂检查发现的多处狭窄会降低钡剂检查的准确性，但降低程度未达到统计学意义。小肠CD狭窄手术成功后，超过90%的患者可在3个月内成功停用类固醇。无法停用类固醇可能提示有遗漏的狭窄。
我们的数据表明，与钡剂造影相比，在接受小肠手术干预的大量CD患者中，仔细的探查和术中肠腔通畅性的腔内测试能发现更多额外的狭窄。
