Ambiru Satoshi, Furuyama Nobuaki, Kimura Fumio, Shimizu Hiroaki, Yoshidome Hiroyuki, Miyazaki Masaru, Shimada Hideaki, Ochiai Takenori
Departments of General Surgery, Surgical Center, Chiba University Hospital, Chiba University Graduate School of Medicine, Chiba, Japan.
J Gastroenterol Hepatol. 2008 Aug;23(8 Pt 2):e379-83. doi: 10.1111/j.1440-1746.2007.05023.x. Epub 2007 Jun 25.
Nonoperative management of cases of adhesive intestinal obstruction would be ideal, especially for patients who have recently undergone surgery to relieve the same condition. We aimed to examine whether hyperbaric oxygen (HBO) therapy might have therapeutic potential for the treatment of postoperative paralytic ileus and recurrent adhesive intestinal obstruction soon after surgery, to relieve adhesive intestinal obstruction, because of its unique mechanisms in these contexts.
A total of 133 patients were enrolled in the present study. We examined non-per os periods, hospital stay, and clinical course according to the postoperative course of the 133 patients.
After surgical intervention, 75 patients left the hospital without morbidity. Nineteen patients were successfully administered prophylactic HBO therapy to facilitate intestinal motility and to prevent paralytic ileus. The remaining 39 patients suffered from postoperative paralytic ileus or early recurrence of obstruction during the same hospitalization period. The patients who underwent prophylactic HBO therapy had significantly shorter non-per os periods and hospital stays after surgery than those who were not initially given HBO therapy (P < 0.05). Similarly, there were significant differences in duration of hospital stay after surgery between patients with HBO therapy as treatment and those who received other conservative therapies (P < 0.05).
HBO therapy may have a prophylactic effect on postoperative paralytic ileus and may be of therapeutic benefit in the management of early recurrent adhesive intestinal obstruction following surgery to relieve adhesive intestinal obstruction.
粘连性肠梗阻病例的非手术治疗是理想的,尤其是对于近期因同样病情接受过手术的患者。我们旨在研究高压氧(HBO)治疗对于术后麻痹性肠梗阻以及术后不久复发性粘连性肠梗阻是否具有治疗潜力,因其在这些情况下具有独特机制,有望缓解粘连性肠梗阻。
本研究共纳入133例患者。我们根据这133例患者的术后病程,检查了禁食期、住院时间和临床过程。
手术干预后,75例患者无并发症出院。19例患者成功接受了预防性HBO治疗,以促进肠道蠕动并预防麻痹性肠梗阻。其余39例患者在同一住院期间发生了术后麻痹性肠梗阻或早期梗阻复发。接受预防性HBO治疗的患者术后禁食期和住院时间明显短于未接受初始HBO治疗的患者(P<0.05)。同样,接受HBO治疗作为治疗手段的患者与接受其他保守治疗的患者术后住院时间也存在显著差异(P<0.05)。
HBO治疗可能对术后麻痹性肠梗阻具有预防作用,并且在缓解粘连性肠梗阻手术后早期复发性粘连性肠梗阻方面可能具有治疗益处。