Frank J W, Sarr M G, Camilleri M
Gastroenterology Research Unit, Mayo Clinic, Rochester, Minnesota.
Am J Gastroenterol. 1994 Mar;89(3):339-44.
Our aim was to assess the outcome of patients whose gastrointestinal motility recording suggested intestinal mechanical obstruction.
Medical records were reviewed for operative reports and alternative diagnoses during at least 1-yr follow-up.
During 1988-1992, 27 of 890 consecutive manometric recordings suggested mechanical obstruction: 20 with non-propagated, prolonged contractions, seven with a pattern of non-propagated clustered contractions that lasted > 30 min. Obstruction was confirmed at laparotomy in 17 (including two with progressive systemic sclerosis) and by radiology in one. In confirmed obstruction, 12 of 18 contrast radiographs performed prior to manometry were either normal or nondiagnostic. One laparotomy was negative for obstruction; nine patients who did not undergo laparotomy were classified as unobstructed. Manometric recordings showed prolonged contractions in two, clustered contractions in three, and a mixed pattern in four. Positive predictive values of these patterns for obstruction were: prolonged contractions, 82%; clustered contractions, 57%; and mixed pattern, 56%.
Thus, non-propagated, prolonged contractions in small bowel should prompt a search for obstruction, even when this is equivocal on barium small bowel radiography.
我们的目的是评估胃肠动力记录提示肠道机械性梗阻患者的结局。
回顾病历以获取手术报告及至少1年随访期间的其他诊断结果。
在1988年至1992年期间，890次连续测压记录中有27次提示机械性梗阻：20次表现为非传播性、延长的收缩，7次表现为持续超过30分钟的非传播性成簇收缩模式。17例经剖腹手术证实有梗阻（包括2例进行性系统性硬化症患者），1例经放射学证实。在确诊为梗阻的患者中，18例在测压前进行的造影检查中有12例结果正常或无诊断意义。1例剖腹手术未发现梗阻；9例未接受剖腹手术的患者被归类为无梗阻。测压记录显示2例有延长的收缩，3例有成簇收缩，4例有混合模式。这些模式对梗阻的阳性预测值分别为：延长收缩，82%；成簇收缩，57%；混合模式，56%。
因此，即使小肠钡剂造影检查结果不明确，小肠非传播性、延长的收缩也应促使寻找梗阻。
