Yagci Gokhan, Kaymakcioglu Nihat, Can Mehmet Fatih, Peker Yusuf, Cetiner Sadettin, Tufan Turgut
Department of General Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
J Invest Surg. 2005 Nov-Dec;18(6):315-20. doi: 10.1080/08941930500328789.
Water-soluble contrast media (Urografin) cause redistribution of intravascular and extracellular fluid into intestinal lumen due to their hyperosmolarity. As a consequence, these media decrease intestinal wall edema and act as a direct stimulant to intestinal peristalsis. In this prospective study, we aimed to examine objectively the therapeutic role and ability of Urografin in patients with postoperative small bowel obstruction for whom failed to respond to conservative treatment. Three hundred and seventeen patients with postoperative small bowel obstruction due to intraperitoneal adhesions were included prospectively in this study. In the Urografin group, 40 mL Urografin diluted in 40 mL distilled water was administered through the nasogastric tube. No contrast media were administered in the control group, but the patients were decompressed via a nasogastric tube continuously. The number of obstruction episode in 317 patients was 338. In total, 199 patients were in the Urografin group, and 118 patients were in the control group. In the Urografin group, 178 (89.4%) patients responded successfully to the treatment, but 21 (11.6%) patients underwent surgical operation. Intensive intraabdominal adhesions and obstructing fibrous bands were observed and repaired in 15 (71.4%) patients at the operation, while 6 patients underwent segmental small intestine resection in control group, conventional management was successful in only 89 (75.4%) patients, and the remaining 29 (24.6%) patients underwent surgical intervention. In conclusion, it was suggested that in patients with intestinal obstruction due to postoperative intra-abdominal adhesion, water-soluble contrast media such as Urografin may be safely administered via a nasogastric tube or oral route and may decrease the need for surgical operation; furthermore, they may help the physician to operate the patients who needs surgery as early as possible.
水溶性造影剂（泛影葡胺）因其高渗性导致血管内和细胞外液重新分布至肠腔。因此，这些造影剂可减轻肠壁水肿，并直接刺激肠道蠕动。在这项前瞻性研究中，我们旨在客观地研究泛影葡胺对保守治疗无效的术后小肠梗阻患者的治疗作用及效果。本前瞻性研究纳入了317例因腹腔粘连导致术后小肠梗阻的患者。在泛影葡胺组，将40 mL泛影葡胺用40 mL蒸馏水稀释后经鼻胃管给药。对照组未给予造影剂，但患者通过鼻胃管持续减压。317例患者的梗阻发作次数为338次。泛影葡胺组共有199例患者，对照组有118例患者。在泛影葡胺组，178例（89.4%）患者治疗成功，但21例（11.6%）患者接受了手术。手术中观察到并修复了15例（71.4%）患者的严重腹腔粘连和梗阻性纤维带，而对照组有6例患者接受了小肠部分切除术，传统治疗仅89例（75.4%）患者成功，其余29例（24.6%）患者接受了手术干预。总之，提示对于术后腹腔粘连所致肠梗阻患者，水溶性造影剂如泛影葡胺可经鼻胃管或口服安全给药，并可减少手术需求；此外，它们可能有助于医生尽早对需要手术的患者进行手术。
