Wu Zhouqiao, Boersema Geesien S A, Dereci Adem, Menon Anand G, Jeekel Johannes, Lange Johan F
Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Eur Surg Res. 2015;54(3-4):127-38. doi: 10.1159/000369529. Epub 2014 Dec 10.
This systematic review summarizes evidence regarding clinical endpoints, early detection, and differential diagnosis of postoperative ileus (POI).
Using MEDLINE, EMBASE, Cochrane, and Web-of-Science, we identified 2,084 articles. Risk of bias and level of evidence (LOE) of the included articles were determined, and relevant results were summarized.
Eleven articles were included, most of which with substantial risks of bias. Bowel motility studies revealed that defecation together with solid food tolerance is the most representative clinical endpoint of POI (LOE: 2b); other clinical signs (e.g. bowel sounds, passage of flatus) did not correlate with a full recovery of bowel motility. Inflammatory parameters including interleukin (IL)-6, IL-1, and TNF-α might assist in an early detection of prolonged POI (LOE: 4). Clinical manifestations (e.g. nausea, vomiting, abdominal distension, bowel sounds, flatus) and X-ray examinations provided limited aid to the differential diagnosis of POI, while CT with Gastrografin had the best specificity and sensitivity (both 100%; LOE: 1c).
Postoperative defecation together with tolerance of solid food intake seems to be the best clinical endpoint of POI. CT has the best differential diagnostic value between POI and other complications. Prospective studies with a high LOE are in great need.
本系统评价总结了关于术后肠梗阻（POI）的临床终点、早期检测和鉴别诊断的证据。
通过检索MEDLINE、EMBASE、Cochrane和科学网，我们识别出2084篇文章。确定纳入文章的偏倚风险和证据水平（LOE），并总结相关结果。
纳入11篇文章，其中大多数存在较大偏倚风险。肠道动力研究表明，排便和对固体食物的耐受是POI最具代表性的临床终点（证据水平：2b）；其他临床体征（如肠鸣音、排气）与肠道动力的完全恢复无关。包括白细胞介素（IL）-6、IL-1和肿瘤坏死因子-α在内的炎症参数可能有助于早期发现持续性POI（证据水平：4）。临床表现（如恶心、呕吐、腹胀、肠鸣音、排气）和X线检查对POI的鉴别诊断帮助有限，而泛影葡胺CT的特异性和敏感性最佳（均为100%；证据水平：1c）。
术后排便和对固体食物摄入的耐受似乎是POI最佳的临床终点。CT在POI与其他并发症之间具有最佳的鉴别诊断价值。迫切需要开展具有高证据水平的前瞻性研究。
