Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Biomedical Research Centre, Queens Medical Centre, Nottingham, NG7 2UH, UK.
J Gastrointest Surg. 2020 Feb;24(2):473-483. doi: 10.1007/s11605-019-04341-7. Epub 2019 Aug 13.
Adhesive small bowel obstruction (ASBO) is a common post-operative cause of hospitalisation. Water-soluble contrast media (WSCM) has become a popular non-surgical approach to treatment. However, previous reviews have concluded with conflicting results. This meta-analysis of randomised controlled trials (RCTs) re-evaluated the therapeutic value of WSCM in the management of ASBO.
A comprehensive search of PubMed, Embase, and Cochrane databases was undertaken to identify RCTs from January 2000 to November 2018. The primary outcomes of length of stay and secondary outcomes of time to resolution, need for surgery, and mortality were extracted from the included studies. Quantitative pooling of the data was based on the random effects model.
Eight hundred and seventy-nine patients from the nine studies were included in the analysis. The administration of oral WSCM reduced the length of hospital stay (weighted mean difference - 0.15 days, P < 0.0001). However, WSCM does not reduce the need for surgery (relative risk 0.84, P < 0.009) and makes no difference to mortality rate (RR 0.99, P < 1.000). The definition of time to resolution of ASBO differed between the studies, ranging from time to passing flatus, to cessation of abdominal pain, and time to initiating oral intake. The significant differences in definition precluded meaningful quantitative pooling of this outcome.
This meta-analysis evaluating the therapeutic value of WSCM has shown that it does not reduce the need for operative management in ASBO or impact mortality rates. It shortens hospital stay by 0.15 days (3.6 h) which is not clinically significant.
粘连性小肠梗阻（ASBO）是一种常见的术后住院原因。水溶性对比剂（WSCM）已成为一种治疗粘连性小肠梗阻的非手术方法。然而，以前的综述得出了相互矛盾的结果。本项随机对照试验（RCT）的荟萃分析重新评估了 WSCM 在 ASBO 治疗中的治疗价值。
从 2000 年 1 月至 2018 年 11 月，对 PubMed、Embase 和 Cochrane 数据库进行了全面检索，以确定 RCTs。从纳入的研究中提取了住院时间和次要结局（缓解时间、手术需求和死亡率）的主要结局。根据随机效应模型对数据进行定量合并。
从 9 项研究中纳入了 879 名患者进行分析。口服 WSCM 可缩短住院时间（加权均数差-0.15 天，P < 0.0001）。但是，WSCM 并未降低手术需求（相对风险 0.84，P < 0.009），也不会影响死亡率（RR 0.99，P < 1.000）。ASBO 缓解时间的定义在不同的研究之间存在差异，从排气时间、腹痛停止时间到开始口服摄入时间不等。由于该结局的定义存在显著差异，因此无法进行有意义的定量合并。
这项评估 WSCM 治疗价值的荟萃分析表明，它不能减少 ASBO 手术治疗的需求或影响死亡率。它将住院时间缩短了 0.15 天（3.6 小时），但这没有临床意义。
