Larichev S E, Shapovalyants S G, Zavyalov B G, Shabrin A V, Omelyanovich D A, Zheleshchikov A L
City Clinical Hospital No. 17, Moscow, Russia.
Pirogov Russian National Research Medical University, Moscow, Russia.
Khirurgiia (Mosk). 2021(6):45-53. doi: 10.17116/hirurgia202106145.
To improve the outcomes of therapy of acute adhesive small bowel obstruction via development of a comprehensive management including CT, deep endoscopy-assisted nasointestinal drainage of small bowel with injection of a water-soluble contrast.
There were 128 patients with acute adhesive small bowel obstruction for the period from 2015 to 2018. The study included 2 groups of patients depending on therapeutic approach and duration of treatment. In the first group, conventional approach for acute adhesive small bowel obstruction was applied. Upon admission, all patients with confirmed acute adhesive small bowel obstruction underwent gastric intubation for decompression of the upper gastrointestinal tract. Barium sulfate injection followed by X-ray examination was performed to assess an effectiveness of therapy. In the second group, computed tomography was performed in addition to X-ray examination and ultrasound. Moreover, conservative treatment included deep endoscopy-assisted nasointestinal drainage and subsequent administration of a water-soluble contrast in addition to traditional approaches.
Therapy was effective in 99 (71.2%) patients; 39 (28.8%) ones required surgery. Deep endoscopy-assisted nasointestinal drainage with injection of a water-soluble contrast was effective in 45 (78.9%) patients. Overall mortality in traditional approach was 1.4%, postoperative mortality - 3.7%. There were no lethal outcomes in case of a new approach.
Deep endoscopy-assisted nasointestinal drainage with injection of a water-soluble contrast is the most effective therapeutic method for acute adhesive small bowel obstruction (78.9%). These findings can significantly improve treatment outcomes in these patients.
通过制定包括CT、深部内镜辅助小肠鼻肠引流并注入水溶性造影剂在内的综合管理方案，改善急性粘连性小肠梗阻的治疗效果。
2015年至2018年期间有128例急性粘连性小肠梗阻患者。根据治疗方法和治疗持续时间，该研究包括两组患者。第一组采用急性粘连性小肠梗阻的传统治疗方法。入院时，所有确诊为急性粘连性小肠梗阻的患者均接受胃插管以进行上消化道减压。进行硫酸钡注射并随后进行X线检查以评估治疗效果。第二组除了进行X线检查和超声检查外，还进行了计算机断层扫描。此外，保守治疗除了传统方法外，还包括深部内镜辅助小肠鼻肠引流及随后注入水溶性造影剂。
99例（71.2%）患者治疗有效；39例（28.8%）患者需要手术治疗。深部内镜辅助小肠鼻肠引流并注入水溶性造影剂在45例（78.9%）患者中有效。传统方法的总死亡率为1.4%，术后死亡率为3.7%。新方法无致死病例。
深部内镜辅助小肠鼻肠引流并注入水溶性造影剂是治疗急性粘连性小肠梗阻最有效的治疗方法（78.9%）。这些发现可显著改善这些患者的治疗效果。
