肠道减压治疗克罗恩病急性小肠梗阻的前瞻性评估

Prospective evaluation of intestinal decompression in treatment of acute bowel obstruction from Crohn’s disease

背景:保守治疗对于克罗恩病急性小肠梗阻是必要的,可避免急症手术。本研究旨在评估采用长胃肠减压管治疗克罗恩病急性小肠梗阻的疗效。方法:本研究为前瞻性观察研究。对用于治疗克罗恩病急性肠梗阻的长胃肠减压管(LT组)和传统鼻胃管(GT组)两种胃肠减压方法进行对比分析。首要结局指标是避免急症手术。此外,分析胃肠减压失败及后续手术干预的预测因素。结果:27例行LT减压和42例行GT减压的克罗恩病急性小肠梗阻患者纳入研究。LT组中有12例(44.4%)患者保守治疗成功,无需手术干预;而GT组中仅有9例(21.4%)患者无需急症手术(P<0.05)。无论是非手术还是手术患者,LT组患者症状缓解的时间均显著快于GT组(均P<0.01)。48小时引流量>500 mL是需手术干预的危险因素,而置管后C反应蛋白下降则是一保护因素(均P<0.05)。对于手术患者,LT组暂时性肠造口率和切口感染率均显著低于GT组(均P<0.05)。对于非手术患者,LT组与GT组的梗阻复发率,无论是内科复发还是外科复发,差异均无统计学意义(均P>0.05)。结论:内镜下放置长胃肠减压管可改善克罗恩病急性肠梗阻患者的急症状态。引流量和置管后C反应蛋白的变化可作为是否需要后续手术干预的临床预测指标。与传统鼻胃管减压相比,采用长管进行胃肠减压,短期并发症更少,且远期梗阻复发率不会增加。

Background:Conservative therapy for Crohn’s disease(CD)-related acute bowel obstruction is essential to avoid emergent surgery.The present study aimed to evaluate the efficacy of using a long intestinal decompression tube(LT)in treatment of CD with acute intestinal obstruction.Methods:This is a prospective observational study.Comparative analysis was performed in CD patients treated with LT(the LT group)and nasogastric tube(the GT group).The primary outcome was the avoidance of emergent surgery.Additionally,predictive factors for failure of decompression and subsequent surgery were investigated.Results:There were 27 and 42 CD patients treated with LT and GT,respectively,in emergent situations.Twelve(44.4%)patients using LT were managed conservatively without laparotomy,while only nine(21.4%)patients in the GT group were spared from emergent surgery(P<0.05).Both in surgery-free and in surgery patients,the time to alleviation of symptoms was significantly shorter in the LT groups than in the GT groups(both P<0.01).C-reactive protein decrease after intubation and 48-hour drainage volume>500mL were predictors of unavoidable surgery(both P<0.05).The rate of temporary stoma and incidence of incision infection in the LT surgery group were significantly lower than those in the GT group(both P<0.05).No significant differences were observed in the frequency of medical and surgical recurrences between the LT and GT groups(all P>0.05).Conclusions:Endoscopic placement of LT could improve the emergent status in CD patients with acute bowel obstruction.The drainage output and changes in C-reactive protein after intubation could serve as practical predictive indices for subsequent surgery.Compared to traditional GT decompression,LT decompression was associated with fewer short-term complications and did not appear to affect long-term recurrence.