Peker K D, Cikot M, Bozkurt M A, Ilhan B, Kankaya B, Binboga S, Seyit H, Alis H
Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey.
Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
Eur J Trauma Emerg Surg. 2017 Aug;43(4):557-566. doi: 10.1007/s00068-016-0709-y. Epub 2016 Jul 18.
Performance of urgent colonoscopy for the purposes of diagnosis and treatment of Ogilvie's syndrome remains controversial. However, no trials have directly compared neostigmine with endoscopic therapy. This study aimed to compare the effect of neostigmine and colonoscopic decompression in the treatment of Ogilvie's syndrome.
This study was designed as a retrospective, non-randomized clinical study of sequential patients. Patients who were diagnosed as having acute colonic pseudo-obstruction were separated into two groups after conservative treatment. Group 1 comprised patients who underwent colonoscopic decompression, because they had a poor first response to neostigmine treatment. Group 2 constituted patients who had a poor first response to colonoscopic decompression, and neostigmine was added to the treatment regimen. Groups 1 and 2 were compared for the success of disease management.
In groups 1 and 2, the average age of the patients was 63.19 years (±14.71 years) and 59.45 years (±15.31 years) (p = 0.312), respectively. No significant difference was determined between the groups in terms of distribution of sex, hospital stay, etiologies, and initial cecal sizes in imaging (p > 0.05). Response to first intervention was statistically significant (p < 0.01). Also, the total response was determined statistically significant for hospital stay if colonoscopic decompression was performed (p < 0.01). No recurrence was determined during the 1-month follow-up in both groups. Although there was no etiologic factor for neostigmine response according to univariate analysis results, colonoscopic success was decreased due to age, sex, and the presence of a cardiac disease.
Although the success rate of neostigmine treatment was significantly lower in our homogeneous groups, no significant decrease was determined in terms of hospital stay, intensive care unit stay, and requirement of colostomy compared with colonoscopic decompression. By comparison, colonoscopic decompression, which was performed by experienced endoscopists as a first-line treatment option, was more effective as an initial therapy and was more effective at avoiding a second treatment modality.
为诊断和治疗奥吉尔维综合征而进行紧急结肠镜检查的效果仍存在争议。然而，尚无试验直接比较新斯的明与内镜治疗的效果。本研究旨在比较新斯的明与结肠镜减压治疗奥吉尔维综合征的效果。
本研究设计为一项对连续患者进行的回顾性、非随机临床研究。被诊断为急性结肠假性梗阻的患者在保守治疗后被分为两组。第1组包括那些对新斯的明治疗首次反应不佳而接受结肠镜减压的患者。第2组由那些对结肠镜减压首次反应不佳且在治疗方案中加入新斯的明的患者组成。比较第1组和第2组疾病管理的成功率。
在第1组和第2组中，患者的平均年龄分别为63.19岁（±14.71岁）和59.45岁（±15.31岁）（p = 0.312）。两组在性别分布、住院时间、病因以及影像学检查中初始盲肠大小方面均未发现显著差异（p > 0.05）。对首次干预的反应具有统计学意义（p < 0.01）。此外，如果进行结肠镜减压，住院时间的总反应具有统计学意义（p < 0.01）。两组在1个月的随访期间均未发现复发。尽管根据单因素分析结果，新斯的明反应不存在病因因素，但由于年龄、性别和心脏病的存在，结肠镜检查的成功率降低。
尽管在我们的同质性组中新斯的明治疗的成功率显著较低，但与结肠镜减压相比，在住院时间、重症监护病房停留时间和结肠造口术需求方面未发现显著降低。相比之下，由经验丰富的内镜医师作为一线治疗选择进行的结肠镜减压作为初始治疗更有效，并且在避免二次治疗方式方面更有效。
