Mori Haruki, Kaneoka Yuji, Maeda Atsuyuki, Takayama Yuichi, Takahashi Takamasa, Onoe Shunsuke, Fukami Yasuyuki
Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan.
Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan.
Surgery. 2017 Jul;162(1):139-146. doi: 10.1016/j.surg.2017.01.023. Epub 2017 Mar 24.
Several studies have investigated the diagnostic and therapeutic role of water-soluble contrast agents in adhesive small bowel obstruction, but there is no clear diagnostic classification for the determination of therapeutic strategy. The aim of this study was to clarify the clinical value of classification using water-soluble contrast agents in patients with adhesive small bowel obstruction.
Between January 2009 and December 2015, 776 consecutive patients with adhesive small bowel obstruction were managed initially with water-soluble contrast agents and were included in the study. Abdominal x-rays were taken 5 hours after administration of 100 mL water-soluble contrast agents and classified into 4 types. The medical records of the patients with adhesive small bowel obstruction were analyzed retrospectively and divided into 2 groups of patients with complete obstruction (ie, the absence of contrast agent in the colon) with (type I) or without (type II) a detectable point of obstruction and a group with an incomplete obstruction (ie, the presence of contrast agent in the colon) with (type IIIA) or without (type IIIB) dilated small intestine.
Types I, II, IIIA, and IIIB were identified in 27, 90, 358, and 301 patients, respectively. The overall operative rate was 16.6%. In the patients treated conservatively (types IIIA and IIIB), 647 patients (98.2%) were treated successfully without operative intervention. The operative rate was 3.4% (n = 12/358) in type IIIA vs 0% (n = 0/301) in the type IIIB group (P = .001). Compared with type IIIA, type IIIB was associated with earlier initiation of oral intake (2.1 vs 2.6 days, P < .001) and a lesser hospital stays (9 vs 11 days, P < .001).
This new classification using water-soluble contrast agents is a simple and useful diagnostic method for the determination of therapeutic strategy for adhesive small bowel obstruction.
多项研究探讨了水溶性造影剂在粘连性小肠梗阻中的诊断和治疗作用，但对于治疗策略的确定尚无明确的诊断分类。本研究的目的是阐明使用水溶性造影剂进行分类对粘连性小肠梗阻患者的临床价值。
2009年1月至2015年12月期间，776例连续性粘连性小肠梗阻患者最初采用水溶性造影剂进行处理，并纳入本研究。在给予100 mL水溶性造影剂5小时后拍摄腹部X线片，并分为4型。对粘连性小肠梗阻患者的病历进行回顾性分析，分为完全性梗阻（即结肠内无造影剂）患者的2组，其中一组有（I型）可检测到的梗阻点，另一组无（II型），以及不完全性梗阻（即结肠内有造影剂）患者的一组，其中一组有（IIIA型）扩张的小肠，另一组无（IIIB型）。
分别在27、90、358和301例患者中识别出I型、II型、IIIA型和IIIB型。总体手术率为16.6%。在保守治疗的患者（IIIA型和IIIB型）中，647例患者（98.2%）未经手术干预成功治疗。IIIA型手术率为3.4%（n = 12/358），而IIIB型组为0%（n = 0/301）（P = .001）。与IIIA型相比，IIIB型患者开始经口摄入更早（2.1天对2.6天，P < .001），住院时间更短（9天对11天，P < .001）。
这种使用水溶性造影剂的新分类方法是确定粘连性小肠梗阻治疗策略的一种简单而有用的诊断方法。
