Liu Rui-Qing, Qiao Shuai-Hua, Wang Ke-Hao, Guo Zhen, Li Yi, Cao Lei, Gong Jian-Feng, Wang Zhi-Ming, Zhu Wei-Ming
Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
Department of Cardiology, Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
Gastroenterol Rep (Oxf). 2019 Aug;7(4):263-271. doi: 10.1093/gastro/goz002. Epub 2019 Mar 30.
Conservative therapy for Crohn's disease (CD)-related acute bowel obstruction is essential to avoid emergent surgery. The present study aimed to evaluate the efficacy of using a long intestinal decompression tube (LT) in treatment of CD with acute intestinal obstruction.
This is a prospective observational study. Comparative analysis was performed in CD patients treated with LT (the LT group) and nasogastric tube (the GT group). The primary outcome was the avoidance of emergent surgery. Additionally, predictive factors for failure of decompression and subsequent surgery were investigated.
There were 27 and 42 CD patients treated with LT and GT, respectively, in emergent situations. Twelve (44.4%) patients using LT were managed conservatively without laparotomy, while only nine (21.4%) patients in the GT group were spared from emergent surgery ( < 0.05). Both in surgery-free and in surgery patients, the time to alleviation of symptoms was significantly shorter in the LT groups than in the GT groups (both < 0.01). C-reactive protein decrease after intubation and 48-hour drainage volume >500 mL were predictors of unavoidable surgery (both < 0.05). The rate of temporary stoma and incidence of incision infection in the LT surgery group were significantly lower than those in the GT group (both < 0.05). No significant differences were observed in the frequency of medical and surgical recurrences between the LT and GT groups (all > 0.05).
Endoscopic placement of LT could improve the emergent status in CD patients with acute bowel obstruction. The drainage output and changes in C-reactive protein after intubation could serve as practical predictive indices for subsequent surgery. Compared to traditional GT decompression, LT decompression was associated with fewer short-term complications and did not appear to affect long-term recurrence.
克罗恩病（CD）相关急性肠梗阻的保守治疗对于避免急诊手术至关重要。本研究旨在评估使用长型肠道减压管（LT）治疗CD伴急性肠梗阻的疗效。
这是一项前瞻性观察性研究。对接受LT治疗的CD患者（LT组）和鼻胃管治疗的患者（GT组）进行比较分析。主要结局是避免急诊手术。此外，还研究了减压失败和后续手术的预测因素。
在紧急情况下，分别有27例和42例CD患者接受了LT和GT治疗。12例（44.4%）使用LT的患者经保守治疗未行剖腹手术，而GT组只有9例（21.4%）患者避免了急诊手术（P<0.05）。无论是未手术患者还是手术患者，LT组症状缓解时间均明显短于GT组（均P<0.01）。插管后C反应蛋白下降和48小时引流量>500 mL是不可避免手术的预测因素（均P<0.05）。LT手术组的临时造口率和切口感染发生率均明显低于GT组（均P<0.05）。LT组和GT组在医疗和手术复发频率方面未观察到显著差异（均P>0.05）。
内镜放置LT可改善CD伴急性肠梗阻患者的紧急状况。插管后的引流输出量和C反应蛋白变化可作为后续手术的实用预测指标。与传统的GT减压相比，LT减压的短期并发症较少，且似乎不影响长期复发。
