Objective To analyze the effect of meglumine diatrizoate on diagnosing and treating adhesiveness small intestinal obstruction. Methods The clinic data of 484 cases of adhesiveness small intestinal obstruction were analyzed retrospectively. Those patients were treated with radiography with 76% of meglumine diatrizoate by orally or injected. Results After taking meglumine diatrizoate, 362 patients were cured, and the other 122 cases were diagnosed clearly and treated with surgery. Conclusions Meglumine diatrizoate can be used to diagnose adhesiveness small intestinal obstruction and confirm where the obstruction is. It can be the routine treatment for adhesiveness small intestinal obstruction and can be used repeatedly. It also can provide evidence to surgical treatment and guide to make the surgical project.
Objective We sought a good understanding of the current role of computed tomography (CT) in the diagnosis of small bowel obstruction (SBO).Methods We looked for the best evidence on computed tomography for diagnosing small bowel obstruction by searching MEDLINE/PubMed (1978-April, 2006), SUMsearch (1978-April, 2006), CNKI (1978-April, 2006) and critically appraised the evidence. Results There was powerful evidence supporting the efficacy of computed tomography in the diagnosis of small bowel obstruction. Given the current evidence together with our clinical experience and considering the patient and his family members, values and preferences, computed tomography was done. We confirmed the diagnosis of strangulating small bowel obstruction, which needed immediate operation. Conclusions Computed tomography is a very useful tool for the diagnosis of small bowel obstruction with high sensibility and specificity.
目的 总结对粪石性小肠梗阻患者的诊治经验。方法 对我院2000～2012年期间收治的45例成人粪石性小肠梗阻患者的病史、X射线表现、CT表现、治疗情况等进行回顾性分析。结果 本组有22例患者发病前曾进食柿子、山楂或黑枣，7例有胃部手术史，9例患有糖尿病。39例行腹部CT，其中35例可见小肠扩张与萎陷肠管移行区椭圆形斑点状团块。22例经非手术治疗缓解，随访2～3个月无肠梗阻复发；23例行剖腹探查，其中1例于术后21 d死于急性呼吸窘迫综合征，其余均治愈。结论 进食富含鞣酸食物史、胃部手术史、糖尿病史、典型螺旋CT表现是诊断的关键因素，部分患者可经保守治疗缓解，若保守治疗无效，则行手术探查，手术应先试行手法碎石，并全程探查胃肠道以避免多发粪石残留。
Objective To explore the bacterial translocation of mesenteric lymph nodes （MLNs） of the ileum and the spectrum of bacteria in patients with small bowel obstruction.Methods Total 84 patients were divided into study group （with small bowel obstruction） and control group （without small bowel obstruction）. MLNs were obtained under sterile conditions intraoperatively， and which were processed for culture of aerobic and anaerobic organisms. The rate of bacterial translocation and postoperative infection were compared between two groups and the species of bacterial translocation was identified. Results The bacterial translocation rate in the study group was higher than that in the control group 〔57.1% （24/42） versus 16.7% （7/42），χ2=14.775， P＜0.01〕. Escherichia coil was the most commonly bacteria （20）. Emergency surgery and age over 70 years were associated with bacterial translocation （P＜0.05）. Postoperative infection complications rate in the bacterial translocation patients was higher than that in the patients without bacterial translocation 〔29.0% （9/31） versus 3.8% （2/53），χ2=10.965，P＜0.05〕. Conclusions Bacterial translocation to MLNs occurres more frequently in patients with small bowel obstruction，non-elective surgery， and elderly.
ObjectiveTo study the application value of mixed formulations consisting of paraffin oil, dimethyl silicone oil, and senna preparations in treatment for incomplete adhesive intestinal obstruction after laparotomy. MethodsOne hundred and twentyeight patients diagnosed incomplete adhesive intestinal obstruction admitted to this hospital from March 2005 to May 2008 were randomly divided into trial group and control group. For the control group, the tradition therapy including fasting, gastrointestinal decompression, fluid replacement therapy, and enema with soap and water were used for treatment. For the trial group, the mixed formulations consisting of paraffin oil, dimethyl silicone oil, and senna preparations were injected into stomach by the nasogastric tube on the basis of traditional treatment used for the control group. Some indicators including the successful rate of nonoperative treatment, the time that obstructive symptoms resolved and returned to normal exhaust and defecation and normal diet, and recurrence rate were compared between two groups. ResultsThe successful rate of nonoperative treatmentin in the trial group were significantly higher than that in the control group 〔92.1% (70/76) versus 69.2% (36/52), Plt;0.01〕. The average time that recovered to normal exhaust and defecation in the trial group and the control group was 32.5 d and 47.8 d, respectively. The average time that recovered to normal diet in the trial group and the control group was 3.2 d and 5.3 d, respectively. The time that recovered to normal exhaust and defecation, and diet in the trial group were significantly shorter than those in the control group (Plt;0.01). The recurrence rate had no significant difference between two groups (Pgt;0.05). ConclusionThe mixed formulations consisting of paraffin oil, dimethyl silicone oil, and senna preparations improve recovery of intestinal function and reduce surgical intervention rate.
ObjectiveTo explore the risk factors affecting operation treatment selection of acute adhesive small bowel obstruction (ASBO), and establish a prediction model of surgical treatment selection to provide a guidance for clinical decision-making. MethodsThe patients with acute ASBO admitted to this hospital and met the inclusion and exclusion criteria, from January 2019 to December 2022, were retrospectively collected, and the patients were assigned into the surgical treatment and conservative treatment according to the treatment selection. The differences in the clinicopathologic factors between the patients with surgical treatment and conservative treatment were compared. Meanwhile, the factors with statistical differences (P<0.05) or the factors with clinical significance judged based on professional knowledge were included to screen the influencing factors of surgical treatment selection using the multivariate logistic regression analysis, and the selected influencing factors were used to construct the logistic regression prediction model equation. The area under the receiver operating characteristic curve (AUC) and its 95% confidence interval (95%CI) was used to evaluate the prediction efficiency of the prediction model equation. ResultsA total of 231 patients with acute ASBO were included, 117 (50.6%) of whom underwent surgical treatment and 114 (49.4%) underwent conservative treatment. In all 16 clinicopathologic factors between the patients with surgical treatment and conservative treatment had statistical differences (P<0.05) including the body mass index (BMI), preopeative high fever, intestinal type, sign of peritonitis, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score excluded age scoring, abdominal surgery history and times of abdominal surgery history, times of pre-admission seek medical advice and preoperative conservative treatment time, the air-liquid level by X-ray plain film, and severe small bowel obstruction and adhesive bands by CT examination, as well as the white blood cell count (WBC), neutrophil percentage, albumin (ALB), and urea nitrogen. The multivariate logistic regression analysis showed that the acute ASBO accompanied by sign of peritonitis (β=1.778, P=0.028), history of abdominal surgery (β=1.394, P=0.022), and adhesive bands (β=1.321, P=0.010) and severe small bowel obstruction (β=1.183, P=0.018) by CT examination, WBC (β=0.524, P＜0.001), APACHEⅡ score excluded age scoring (β=0.291, P＜0.001), and BMI (β=0.191, P=0.011) had positive impacts on adopting surgical treatment, while preoperative ALB (β=–0.101, P=0.023) and conservative treatment time (β=–0.391, P＜0.001) had negative impacts on adopting surgical treatment. The accuracy, specificity, and sensitivity of the logistic regression prediction model equation constructed according to these 9 influencing factors were 84.8%, 71.1%, and 77.7%, respectively. The AUC (95%CI) of the prediction model equation to distinguish selection of surgical treatment from conservative treatment was 0.942 (0.914, 0.970). ConclusionsAccording to the preliminary results of this study, surgical treatment is recommended for patients with acute ASBO accompanied by signs of peritonitis, history of abdominal surgery, adhesive bands and severe small bowel obstruction by CT, increased preoperative WBC, high APACHEⅡ score excluded age scoring, high BMI, preoperative low ALB level, and shorter preoperative conservative treatment time. And the logistic prediction model equation constructed according to these characteristics in this study has a good discrimination for patients with surgical treatment or conservative treatment selection.