Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China (mainland).
Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland).
Med Sci Monit. 2021 Mar 27;27:e930046. doi: 10.12659/MSM.930046.
BACKGROUND This retrospective cohort study from a single center aimed to compare patient outcomes following the use of the water-soluble contrast medium Gastrografin in the treatment of adhesive small bowel obstruction (ASBO) in patients with and without a history of chronic radiation enteropathy (CRE). MATERIAL AND METHODS Fifty-nine patients with CRE-induced small bowel obstruction (SBO) and 53 patients with ASBO at Jinling Hospital between April 2014 and February 2018 were enrolled. The patients were given 100 ml Gastrografin through a naso-jejunal tube, and erect abdominal X-rays were taken. Risk factors were found to be correlated with successful non-operative management (SNM) through statistical analyses. RESULTS The success rate of conservative treatment was higher in the Gastrografin group than in the control group (P<0.05). The Gastrografin challenge test is predictive of need for surgery in CRE-induced SBO and ASBO (AUC=0.860 and 0.749, respectively). The predictors associated with SNM in the CRE-induced SBO group were the total dose of radiotherapy, the Gastrografin challenge test, and previous operations for SBO. In the ASBO group, the predictors were the Gastrografin challenge test and previous operations for SBO. The operation rate of SBO patients with Gastrografin treatment was significantly lower than that in the control group (P<0.05). CONCLUSIONS The findings from this study showed that the use of Gastrografin effectively resolved ASBO in patients with and without a history of CRE, but a long-term requirement for surgery could not be avoided. The Gastrografin challenge may be a useful test to predict surgical outcomes.
本研究为单中心回顾性队列研究，旨在比较水溶性造影剂泛影葡胺治疗伴有和不伴有慢性放射性肠炎（CRE）病史的粘连性小肠梗阻（ASBO）患者的疗效。
2014 年 4 月至 2018 年 2 月，南京金陵医院收治 59 例 CRE 所致小肠梗阻（SBO）患者和 53 例 ASBO 患者。经鼻空肠管注入 100ml 泛影葡胺后，拍摄立位腹部 X 线片。通过统计学分析，发现与非手术治疗成功相关的危险因素。
与对照组相比，泛影葡胺组的保守治疗成功率更高（P<0.05）。泛影葡胺激发试验对 CRE 所致 SBO 和 ASBO 均具有预测手术的价值（AUC 分别为 0.860 和 0.749）。在 CRE 所致 SBO 组中，与 SNM 相关的预测因素包括放射治疗总剂量、泛影葡胺激发试验和既往 SBO 手术。在 ASBO 组中，预测因素为泛影葡胺激发试验和既往 SBO 手术。泛影葡胺治疗 SBO 患者的手术率明显低于对照组（P<0.05）。
本研究结果表明，泛影葡胺有效治疗伴有和不伴有 CRE 病史的 ASBO，但不能避免长期手术需求。泛影葡胺激发试验可能是一种有用的预测手术结局的试验。
