Fukami Yasuyuki, Kaneoka Yuji, Maeda Atsuyuki, Takayama Yuichi, Takahashi Takamasa, Uji Masahito
Department of Surgery, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan.
World J Surg. 2018 Jan;42(1):88-92. doi: 10.1007/s00268-017-4174-5.
Several studies have investigated the diagnostic and therapeutic role of water-soluble contrast agents (WSCAs) in adhesive small bowel obstruction (SBO). However, the clinical effect of WSCA for SBO without previous intraabdominal operation (i.e., virgin abdomen, VA) is unclear. The aim of this study was to clarify the clinical effect of WSCA for SBO in the VA.
Between January 2008 and December 2015, 838 consecutive patients with SBO were initially managed with WSCA and were included in the study. Abdominal X-rays were taken 5 h after administration of 100 ml WSCA and classified into complete/incomplete obstruction groups. The medical records of the patients with SBO were retrospectively analyzed and divided into two groups of patients with VA or non-VA.
A total of 44 and 794 VA and non-VA patients were identified, respectively. Six VA patients (13%) and 121 non-VA patients (15%) were classified with complete obstruction (p = 1.000) and subjected to operative exploration on the same day. There were no significant differences in the duration of nasogastric tube decompression (2.2 versus 2.5 days, p = 0.400) and intervals until the initiation of oral intake (2.4 versus 2.6 days, p = 0.553) between the VA and non-VA groups. The overall operative rate was 16% in the VA and 17% in the non-VA groups (p = 1.000). Compared with non-VA, VA was associated with shorter hospital stays (9.6 versus 11.3 days, p = 0.006).
WSCA for SBO in the VA is as effective as in non-VA patients in terms of a therapeutic strategy.
多项研究探讨了水溶性造影剂（WSCA）在粘连性小肠梗阻（SBO）中的诊断和治疗作用。然而，WSCA对既往无腹腔内手术史（即初发腹腔，VA）的SBO的临床效果尚不清楚。本研究的目的是阐明WSCA对VA中SBO的临床效果。
2008年1月至2015年12月期间，838例连续的SBO患者最初接受WSCA治疗并纳入研究。在给予100 ml WSCA后5小时拍摄腹部X线片，并分为完全/不完全梗阻组。对SBO患者的病历进行回顾性分析，并分为VA或非VA两组患者。
分别确定了44例VA患者和794例非VA患者。6例VA患者（13%）和121例非VA患者（15%）被分类为完全梗阻（p = 1.000），并在同一天接受手术探查。VA组和非VA组之间在鼻胃管减压持续时间（2.2天对2.5天，p = 0.400）和开始经口进食的间隔时间（2.4天对2.6天，p = 0.553）方面没有显著差异。VA组的总体手术率为16%，非VA组为17%（p = 1.000）。与非VA相比，VA患者的住院时间更短（9.6天对11.3天，p = 0.006）。
就治疗策略而言，VA中SBO使用WSCA与非VA患者一样有效。
