Zielinski Martin D, Haddad Nadeem N, Cullinane Daniel C, Inaba Kenji, Yeh Dante D, Wydo Salina, Turay David, Pakula Andrea, Duane Therese M, Watras Jill, Widom Kenneth A, Cull John, Rodriguez Carlos J, Toschlog Eric A, Sams Valerie G, Hazelton Joshua P, Graybill John Christopher, Skinner Ruby, Yune Ji-Ming
From the Mayo Clinic (M.D.Z., N.N.H.), Rochester, Minnesota; Marshfield Clinic (D.C.C.), Marshfield, Wisconsin; University of Southern California (K.I.), Los Angeles, California; Massachusetts General Hospital (D.D.Y.), Chelsea, Massachusetts; Cooper University (S.W., J.P.H.), Camden, New Jersey; Loma Linda University (D.T., J.-M.Y.), Loma Linda, California; Kern Medical Center (A.P., R.S.), Bakersfield, California; John Peter Smith Hospital (T.M.D.), Ft. Worth, Texas; Inova Fairfax Hospital (J.W.), Falls Church, Virginia; Geisinger Medical Center (K.A.W.), Danville, Pennsylvania; Greenville Memorial Hospital (J.C.), Greenville, South Carolina; Walter Reed National Military Medical Center (C.J.R.), Bethesda, Maryland; East Carolina University (E.A.T.), Greenville, North Carolina; and San Antonio Military Medical Center (V.G.S., J.C.G.), San Antonio, Texas.
J Trauma Acute Care Surg. 2017 Jul;83(1):47-54. doi: 10.1097/TA.0000000000001499.
Existing trials studying the use of Gastrografin for management of adhesive small bowel obstruction (SBO) are limited by methodological flaws and small sample sizes. We compared institutional protocols with and without Gastrografin (GG), hypothesizing that a SBO management protocol utilizing GG is associated with lesser rates of exploration, shorter length of stay, and fewer complications.
A multi-institutional, prospective, observational study was performed on patients appropriate for GG with adhesive SBO. Exclusion criteria were internal/external hernia, signs of strangulation, history of abdominal/pelvic malignancy, or exploration within the past 6 weeks. Patients receiving GG were compared to patients receiving standard care without GG.
Overall, 316 patients were included (58 ± 18 years; 53% male). There were 173 (55%) patients in the GG group (of whom 118 [75%] successfully passed) and 143 patients in the non-GG group. There were no differences in duration of obstipation (1.6 vs. 1.9 days, p = 0.77) or small bowel feces sign (32.9% vs. 25.0%, p = 0.14). Fewer patients in the GG protocol cohort had mesenteric edema on CT (16.3% vs. 29.9%; p = 0.009). There was a lower rate of bowel resection (6.9% vs. 21.0%, p < 0.001) and exploration rate in the GG group (20.8% vs. 44.1%, p < 0.0001). GG patients had a shorter duration of hospital stay (4 IQR 2-7 vs. 5 days IQR 2-12; p = 0.036) and a similar rate of complications (12.5% vs. 17.9%; p = 0.20). Multivariable analysis revealed that GG was independently associated with successful nonoperative management.
Patients receiving Gastrografin for adhesive SBO had lower rates of exploration and shorter hospital length of stay compared to patients who did not receive GG. Adequately powered and well-designed randomized trials are required to confirm these findings and establish causality.
Therapeutic, level III.
现有关于使用泛影葡胺治疗粘连性小肠梗阻（SBO）的试验存在方法学缺陷和样本量小的局限性。我们比较了采用和未采用泛影葡胺（GG）的机构方案，假设使用GG的SBO管理方案与更低的探查率、更短的住院时间和更少的并发症相关。
对适合使用GG治疗粘连性SBO的患者进行了一项多机构、前瞻性观察性研究。排除标准为内/外疝、绞窄迹象、腹部/盆腔恶性肿瘤病史或过去6周内进行过探查。将接受GG治疗的患者与接受不使用GG的标准治疗的患者进行比较。
总体而言，共纳入316例患者（年龄58±18岁；53%为男性）。GG组有173例（55%）患者（其中118例[75%]成功通过），非GG组有143例患者。便秘持续时间（1.6天对1.9天，p = 0.77）或小肠粪便征（32.9%对25.0%，p = 0.14）无差异。GG方案队列中CT显示肠系膜水肿的患者较少（16.3%对29.9%；p = 0.009）。GG组的肠切除率（6.9%对21.0%，p < 0.001）和探查率较低（20.8%对44.1%，p < 0.0001）。GG组患者的住院时间较短（四分位间距4天2 - 7天对5天四分位间距2 - 12天；p = 0.036），并发症发生率相似（12.5%对17.9%；p = 0.20）。多变量分析显示，GG与非手术治疗成功独立相关。
与未接受GG治疗的患者相比，接受泛影葡胺治疗粘连性SBO的患者探查率更低，住院时间更短。需要开展有足够样本量和精心设计的随机试验来证实这些发现并确定因果关系。
治疗性，III级。
