Ng Zi Qin, Hsu Vivien, Tee William Wei Han, Tan Jih Huei, Wijesuriya Ruwan
Department of General Surgery, St John of God Midland Hospital, Midland 6056, Western Australia, Australia.
Department of Radiology, St John of God Midland Hospital, Midland 6056, Western Australia, Australia.
World J Gastrointest Surg. 2023 Jun 27;15(6):1116-1124. doi: 10.4240/wjgs.v15.i6.1116.
Majority of adhesive small bowel obstruction (SBO) cases can be managed non-operatively. However, a proportion of patients failed non-operative management.
To evaluate the predictors of successful non-operative management in adhesive SBO.
A retrospective study was performed for all consecutive cases of adhesive SBO from November 2015 to May 2018. Data collated included basic demographics, clinical presentation, biochemistry and imaging results and management outcomes. The imaging studies were independently analyzed by a radiologist who was blinded to the clinical outcomes. The patients were divided into group A operative (including those that failed initial non-operative management) and group B non-operative for analysis.
Of 252 patients were included in the final analysis; group A ( = 90) (35.7%) and group B ( = 162) (64.3%). There were no differences in the clinical features between both groups. Laboratory tests of inflammatory markers and lactate levels were similar in both groups. From the imaging findings, the presence of a definitive transition point [odds ratio (OR) = 2.67, 95% confidence interval (CI): 0.98-7.32, = 0.048], presence of free fluid (OR = 2.11, 95%CI: 1.15-3.89, = 0.015) and absence of small bowel faecal signs (OR = 1.70, 95%CI: 1.01-2.88, = 0.047) were predictive of the need of surgical intervention. In patients that received water soluble contrast medium, the evidence of contrast in colon was 3.83 times predictive of successful non-operative management (95%CI: 1.79-8.21, = 0.001).
The computed tomography findings can assist clinicians in deciding early surgical intervention in adhesive SBO cases that are unlikely to be successful with non-operative management to prevent associated morbidity and mortality.
大多数粘连性小肠梗阻（SBO）病例可采用非手术治疗。然而，一部分患者非手术治疗失败。
评估粘连性SBO非手术治疗成功的预测因素。
对2015年11月至2018年5月期间所有连续性粘连性SBO病例进行回顾性研究。收集的数据包括基本人口统计学资料、临床表现、生化及影像学检查结果和治疗结果。影像学研究由一名对临床结果不知情的放射科医生独立分析。将患者分为A组（手术组，包括初始非手术治疗失败的患者）和B组（非手术组）进行分析。
最终纳入分析252例患者；A组（n = 90）（35.7%），B组（n = 162）（64.3%）。两组临床特征无差异。两组炎症标志物和乳酸水平的实验室检查结果相似。从影像学表现来看，存在明确的移行点[比值比（OR）= 2.67，95%置信区间（CI）：0.98 - 7.32，P = 0.048]、存在游离液体（OR = 2.11，95%CI：1.15 - 3.89，P = 0.015）以及不存在小肠粪样征（OR = 1.70，95%CI：1.01 - 2.88，P = 0.047）提示需要手术干预。在接受水溶性造影剂的患者中，结肠内有造影剂的证据提示非手术治疗成功的可能性为3.83倍（95%CI：1.79 - 8.21，P = 0.001）。
计算机断层扫描结果可帮助临床医生对粘连性SBO病例早期决定手术干预，这些病例非手术治疗不太可能成功，以预防相关的发病率和死亡率。
