Bueno-Lledó Jose, Barber Sebastian, Vaqué Javier, Frasson Mateo, Garcia-Granero Eduardo, Juan-Burgueño Manuel
Department of Digestive Surgery, Hospital La Fe, University of Valencia, Valencia, Spain.
Dig Surg. 2016;33(1):26-32. doi: 10.1159/000441530. Epub 2015 Nov 17.
Gastrografin represents a useful tool in the diagnosis and management of adhesive small bowel obstruction (ASBO). The aim of this study is to identify variables with negative influence in nonoperative management with gastrografin.
From August 2008 to March 2013, 223 consecutive patients with 235 episodes of ASBO were included and received gastrografin. A protocol for prospective data collection was developed. In order to explore factors related to the failure of nonoperative treatment, univariate and multivariate analysis were performed.
One hundred and ninety eight episodes responded to nonoperative treatment (84.2% of success) and 33 patients (15.8%) required surgical intervention. Only 3 patients of the gastrografin cohort with contrast in colon, required surgery. Predictive factors of failure of nonoperative management with gastrografin were patients aged above 65 (p = 0.01; OR 1.791, 95% CI 1.41-2.19), with a history of 2 or more previous laparotomies (p = 0.03; OR 2.91, 95% CI 2.19-3.71), and who had undergone previous abdominal surgery due to ASBO (p = 0.002; OR 1.381, 95% CI 1.10-1.79).
Patient age, the number of previous laparotomies, and the fact that previous abdominal surgery was conducted due to ASBO are indicative of unsuccessful management with gastrografin.
泛影葡胺是诊断和处理粘连性小肠梗阻（ASBO）的一种有用工具。本研究的目的是确定在泛影葡胺非手术治疗中有负面影响的变量。
2008年8月至2013年3月，连续纳入223例发生235次ASBO发作的患者并给予泛影葡胺。制定了前瞻性数据收集方案。为了探究与非手术治疗失败相关的因素，进行了单因素和多因素分析。
198次发作对非手术治疗有反应（成功率84.2%），33例患者（15.8%）需要手术干预。泛影葡胺组中只有3例结肠内有造影剂的患者需要手术。泛影葡胺非手术治疗失败的预测因素为年龄大于65岁（p = 0.01；OR 1.791，95%CI 1.41 - 2.19）、有2次或更多次既往剖腹手术史（p = 0.03；OR 2.91，95%CI 2.19 - 3.71）以及既往因ASBO接受过腹部手术（p = 0.002；OR 1.381，95%CI 1.10 - 1.79）。
患者年龄、既往剖腹手术次数以及既往因ASBO接受腹部手术这一事实提示泛影葡胺治疗失败。
