Value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: A prospective evaluation

AIM: Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need for operative treatment, a potential therapeutic role of this agent in adhesive small bowel obstruction has been suggested. This study aimed at evaluating the effectiveness of gastrografin in adhesive small bowel obstruction when conservative treatment failed.METHODS: Patients with adhesive small bowel obstruction were given trial conservative treatment unless there was fear of bowel strangulation. Those responded in the initial 48 h had conservative treatment continued. Patients who showed no improvement in the initial 48 h were given 100 mL of gastrografin through nasogastric tube followed by serial abdominal radiographs. Patients with the contrast appeared in large bowel within 24 h were regarded ashaving partial obstruction and conservative treatment wascontinued. Patients in which the contrast failed to reachlarge bowel within 24 h were considered to have completeobstruction and laparotomy was performed.RESULTS: Two hundred and twelve patients with 245episodes of adhesive obstruction were included. Fifteenpatients were operated on soon after admission due tofear of strangulation. One hundred and eighty-six episodesof obstruction showed improvement in the initial 48 h andconservative treatment was continued. Two patients hadsubsequent operations because of persistent obstruction.Forty-four episodes of obstruction showed no improvementwithin 48 h and gastrografin was administered. Sevenpatients underwent complete obstruction surgery. Partialobstruction was demonstrated in 37 other cases, obstruction resolved subsequently in all of them except one patient who required laparotomy because of persistent obstruction. The overall operative rate in this study was 10%. There was no complication that could be attributed to the use of gastrografin.CONCLUSION: The use of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment is safe and reduces the need for surgical intervention.

Gastric and enteric anisakiasis successfully treated with Gastrografin therapy: A case report

We report a case of a 59-year-old woman who was diagnosed with gastric and small intestinal anisakiasis, which was successfully treated with endoscopic extraction and Gastrografin therapy. She was admitted to our hospital with epigastric pain and vomiting one day after eating raw fish. She exhibited tenderness in the epigastrium without obvious rebound tenderness or guarding. Computed tomography (CT) demonstrated segmental edema of the intestinal wall with proximal dilatation and a small number of ascites. Because enteric anisakiasis was suspected based on the patient's history of recent raw fish consumption and abdominal CT, we performed gastroscopy and confirmed that nine Anisakis larvae were attached to the gastric mucosa. All of the Anisakis larvae were extracted via endoscopy, and the patient was diagnosed with gastric and enteric anisakiasis. Additionally, in the hospital, we performed ileography twice using Gastrografin, which led to shortened hospital stay. Based on the clinical results of this case, we suggest that Gastrografin therapy is a safe, convenient, and useful method to extract enteric Anisakis larvae.

不同部位肠梗阻影像学检查的诊断意义

目的探讨腹部平片检查、泛影葡胺口服法造影、64层螺旋cT检查对不同部位肠梗阻的诊断意义。方法回顾性分析142例肠梗阻患者资料，均行腹部平片、泛影葡胺造影和cT检查，比较其诊断效果。结果三者对小肠梗阻诊断率为62．5％、85％、77．5％，部位诊断率为0％、90％、78．75％，原因诊断率为0％、71％、65％。三者对大肠梗阻诊断率为53．23％、73．17％、92％，部位诊断率为38．17％、60．98％、98％，CT检查对梗阻原因诊断率为91％。结论64层螺旋cT检查对肠梗阻部位、原因诊断有极大意义，尤适用于大肠梗阻。泛影葡胺造影在小肠梗阻的诊断和治疗中均有较好的临床应用价值，是CT检查的有益补充。

消化道泛影葡胺造影对肠梗阻的诊断价值

目的：探讨消化道泛影葡胺造影对肠梗阻的诊断价值。方法：选取19例临床拟诊肠梗阻病例,碘过敏试验均为阴性,将76%的泛影葡胺注射液60～100ml加等量生理盐水稀释,经口服或鼻胃管注入胃内,进行透视观察。结果：19例患者应用泛影葡胺造影后,胃肠道均显影良好。15例为机械性肠梗阻,1例为肠功能紊乱,3例排除肠梗阻。机械性肠梗阻病例中5例为肿瘤所致;9例为粘连性肠梗阻。粘连性肠梗阻中2例在检查过程中症状即有明显缓解。结论：消化道泛影葡胺造影检查能较好地反映胃肠道功能状态,对肠梗阻病因、病变部位的诊断具有较好的临床应用价值。

口服泛影葡胺胃肠造影在判断单纯性机械性小肠梗阻手术时机中的应用

目的探讨口服泛影葡胺胃肠造影在判断单纯性机械性小肠梗阻（MSBO）手术时机中的作用。方法回顾分析2009年1月至2010年12月行口服泛影葡胺胃肠造影的单纯性MSBO病例，造影结果阳性者行手术治疗，阴性者行非手术治疗。结果共117例行口服泛影葡胺造影的单纯性MSBO病例，其中粘连63．2％、肿瘤12．0％、胃石13．7％、内疝（无手术史）3．4％、原因不明7．7％，造影阳性46例，阴性71例，泛影葡胺胃肠造影用于判断单纯性MSBO手术的特异性和敏感性分别为100％和97．3％。结论口服泛影葡胺胃肠造影可以较为准确判断单纯性MSBO是否需要手术治疗，特别是区分不需要手术治疗的病例。

善宁联合泛影葡胺治疗老年人黏连性小肠梗阻

目的 探讨老年人黏连性小肠梗阻保守治疗安全有效方法。方法 6 7例老年黏连性小肠梗阻病人 ,随机分成A组 35例 ,加用善宁 0 .1mg皮下注射q8h,并经胃管注入 76 %的泛影葡胺10 0ml;B组 32例为对照组。结果 A组保守治疗成功者 32例 ,B组 2 6例 ;A组胃肠引流量少于B组 ;第一次排气排便时间短于B组 ;住院时间短于B组。A组 3例 ,B组 6例中转手术治疗 ;A组无死亡 ,未发生因保守治疗延误病情 ,B组一例因术后肺部感染加重而死亡。结论 善宁联合泛影葡胺治疗老年人黏连性小肠梗阻 ,安全有效 ,临床上可以推广。

复方泛影葡胺在直肠癌Miles术后低位小肠梗阻治疗中的应用

评价复方泛影葡胺在直肠癌Miles术后低位小肠梗阻治疗中的作用。选择直肠癌Miles术后低位小肠梗阻患者32例,随机分成对照组和研究组,其中16例对照组经造口置入一次性吸痰管灌肠治疗,其余16例研究组在吸痰管灌肠治疗基础上联合经口服用复方泛影葡胺治疗。观察两组患者的腹围变化、肠梗阻缓解时间、住院时间及影像学肠管直径变化,并观察其疗效。研究组直肠癌Miles术后低位小肠梗阻缓解率为100%(16/16),并成功接受了保守治疗。研究组患者的腹围缩小程度、肠梗阻缓解时间、住院时间及影像学肠管直径缩小程度明显优于对照组,其差异有统计学意义(P<0.05)。研究组随访6个月无一例肠梗阻复发或再手术治疗。经造口置入一次性吸痰管灌肠治疗联合经口复方泛影葡胺治疗直肠癌Miles术后低位小肠梗阻是安全、经济、有效的方法,不仅能缩短住院时间及住院费用,也能避开接受手术之苦,值得临床推广。

泛影葡胺在腹部术后早期肠梗阻诊断和治疗的临床分析

目的:探讨泛影葡胺在腹部手术早期肠梗阻诊断和治疗上的价值。方法:回顾性分析2008年1月-2013年12月本院收治的160例腹部术后早期肠梗阻患者的临床资料,其中使用泛影葡胺治疗的80例患者作为治疗组,未使用泛影葡胺治疗的80例患者作为对照组。观察两组的治疗效果,比较两组第一次排气时间、梗阻缓解时间等指标的差异。结果:对照组保守治疗成功55例,成功率为69%,中转手术25例,手术率为31%;治疗组保守治疗成功72例,成功率90%,中转手术8例,手术率10%。两组在第一次肛门排气时间、梗阻缓解时间及保守治疗成功率上比较差异均有统计学意义(P<0.01)。结论:口服泛影葡胺是术后早期肠梗阻诊断和治疗上一种安全有效的方法。

泛影葡胺在治疗粘连性不全性小肠梗阻中的应用

目的评价泛影葡胺在治疗粘连性不全性小肠梗阻(APSBO)中的应用。方法对APSBO保守治疗48h无效的患者经胃管注入76%的泛影葡胺100ml,24h内到达结肠的继续保守治疗直至出院,24h未到达结肠的行手术治疗。结果本组72例经48h保守治疗,无效的25例经胃管注入100ml泛影葡胺,22例24h造影剂到达结肠继续保守治疗直至出院,3例24h造影剂未到达结肠行手术治疗,泛影葡胺能使88%(22/25)的患者避免手术。也将APSBO总体手术率从20%30%降到9.7%(7/72)。结论经胃管注入泛影葡胺是非手术治疗粘连性肠梗阻安全有效的方法,能减少这类病人的手术发生。

泛影葡胺联合生长抑素治疗粘连性肠梗阻的临床应用价值

目的探讨泛影葡胺联合生长抑素治疗粘连性肠梗阻(AIO)的应用价值。方法 59例AIO患者,随机分为A组(30例)与B组(29例)。A组在常规治疗的基础上给予生长抑素治疗,B组在A组治疗的基础上给予泛影葡胺治疗,比较两组治疗效果。结果 A组治愈率为80.00%,B组治愈率为79.31%,两组比较差异无统计学意义(P>0.05)。B组症状改善时间、肛门排气时间、排便时间、住院时间明显少于A组(P<0.05)。结论泛影葡胺联合生长抑素治疗AIO见效快、安全,值得推广应用。

泛影葡胺在胃癌术后不全性肠梗阻中的应用研究

目的研究胃癌术后并发的暂时不全性肠梗阻患者进行泛影葡胺造影的可行性。方法选取我院60例胃癌术后并发不全性肠梗阻患者为研究对象,术后均行上消化道造影检查确认为不全性肠梗阻,收治时间为2014年10月至2016年10月,所有患者按造影剂类型分为泛影葡胺组(27例)和欧乃派克组(33例)。对比两组患者一般资料、手术切除方式、合并症以及、血生化指标,并进行术后因不全性肠梗阻行二次剖腹手术的风险因素和保护因素的Logistic单因素、多因素分析。结果两组患者性别、年龄及手术切除方式、术前合并证、既往手术史、术前新辅助治疗史、术前血红蛋白、术前总蛋白、术前白蛋白水平均无显著差异(P>0.05);术后首次排气、排便时间及住院时间、因肠梗阻二次剖腹手术发生率有显著差异(P<0.05)。术后因不全性肠梗阻行二次剖腹手术与术后血红蛋白<120 g/L、术后总蛋白<55 g/L、术后白蛋白<36 g/L、手术时间>300 min、手术类型(姑息与根治)无关(P>0.05);Logistic多因素回归分析结果显示:术后下地时间>3 d、行腹腔镜手术可降低术后因不全性肠梗阻行二次剖腹手术的发生率,术后行泛影葡胺造影检查与术后因不全性肠梗阻行二次剖腹手术直接相关(P<0.05)。结论胃癌术后并发不全性肠梗阻的影响因素较多,并发不全性肠梗阻后行上消化道泛影葡胺造影检查不仅有助于明确诊断,并可有效促进肠梗阻再通。

水溶性造影剂在粘连性小肠梗阻治疗中的价值

目的探讨水溶性造影剂（泛影葡胺）在粘连性小肠梗阻治疗中的价值。方法明确诊断为小肠梗阻的患者,不合并肠穿孔、腹膜炎及绞窄性肠梗阻等需要急诊手术的情况。采用前瞻性研究方法,将入组的57例患者分为2组：对照组与治疗组。对照组给予常规治疗,如禁食、胃肠减压、灌肠、静脉补液等;治疗组除常规保守治疗方法外,患者口服或均经胃肠减压管注入76%泛影葡胺60~100 m L并夹管1小时,观察两组非手术治疗的有效率、小肠梗阻缓解时间、住院时间以及并发症的发生情况。结果应用泛影葡胺的治疗组非手术治疗的有效率明显高于对照组（83.3%VS 55.6%）,差异有统计学意义;非手术治疗有效的两组患者中,治疗组患者在肠鸣音恢复时间9.56±3.47 h VS 19.67±3.90 h）、肛门排气时间（11.24±3.15 h VS 22.6±4.14 h）、每日胃肠减压量（179.20±68.79 m L VS 323.33±91.31 m L）、住院时间（5.0±1.83 d VS 8.20±2.15 d）均明显小于对照组,各指标间的比较均有显著性差异。两组均未出现严重并发症。结论泛影葡胺治疗小肠梗阻疗效确切,值得推广应用。

泛影葡胺在粘连性小肠梗阻中的临床应用

目的：探讨泛影葡胺在粘连性小肠梗阻中的诊断及治疗效果和手术时机的选择。方法：对51例粘连性小肠梗阻患者经胃管注A．76％泛影葡胺60-100ml，行胃肠道造影，通过腹部x线摄片动态观察造影剂在胃肠道中的位置及通过情况，以确定梗阻部位以及梗阻是否完全，从而确定手术时机。结果：51例中36例造影剂在6～24h后到达结肠而给予保守治疗，平均症状缓解时间为14．6h，1～4d（平均2．8d）后症状消失。另15例见造影剂不能到达结肠或症状体征加重而行手术治疗，均获痊愈。结论：泛影葡胺能促进肠梗阻缓解及缩短住院时间，同时还为早期手术提供科学依据。

口服泛影葡胺造影检查在粘连性小肠梗阻中的应用

目的探讨口服泛影葡胺造影检查在粘连性小肠梗阻中的诊断及治疗价值。方法 48例粘连性小肠梗阻患者口服76%泛影葡胺60-100 ml,行胃肠道造影检查,动态观察造影剂在胃肠道中的位置及通过情况,确定梗阻部位及梗阻的具体情况。结果 38例患者造影剂在6-24 h后到达结肠,肠梗阻症状消失,另10例患者造影剂未到达结肠,症状、体征加重而行手术治疗,均获痊愈。结论口服泛影葡胺造影检查可以有效缩短肠梗阻缓解时间及住院时间,是治疗粘连性小肠梗阻的一种安全有效的方法,同时可以为早期手术提供线索。

Effect of water-soluble contrast in colorectal surgery: A prospective randomized trial

AIM: Postoperative gastrointestinal-tract motility is normally delayed. Early feeding after colorectal surgery has beenreposed recently, but late feeding is common. Gastrografin not only enhances bowel peristalsis, but also decreases bowel-wall edema. Whether contrast medium allows early oral feeding and reduces the duration of hospitalization requires clarification.METHODS: Fifty patients underwent elective colorectal surgery in a regional medical center. Patients were prospectively randomized into a Gastrografin group or control group (n = 25 each). Patients in the Gastrografin group began their feeding schedule with 100 mL of 5% dextrose water with 100 mL of Gastrografin on postoperative d 3 and were advanced to a full liquid diet when the contrast reached the colon in 4 h. Patients in the control group began their feeding schedule with 200 mL of 5% dextrosewater on postoperative d 3 and were advanced to a full liquid diet after the passage of flatus and stool. Nasogastric tubes were inserted for persistent postoperative vomiting. Fullness, nausea, vomiting, complications, time of anesthesia, time of operation, time of mobilization, time of oral feeding, and duration of hospital stay were recorded and analyzed with Student's t-test.RESULTS: In the Gastrografin group, one patient hadaspiration pneumonia and one patient had anastomotic leakage resulting in sepsis and eventual death. This mortality was excluded from the subsequent statistical analysis. In the control group, two patients had wound infections. There was no significant difference between the two groups at the time of anesthesia, time of operation, or time of mobilization. There were significant differences between the two groups in the time of oral feeding (3.3±0.3 d in the Gastrografin group vs4.8±0.4 d in the control group; P = odds ratio--, 95%CI [-0.5 to +0.7 d]) and in the length of hospital stay (7.6±1.1 d in the Gastrografingroup vs10.2±1.3 d in the control group; P = odds ratio--, 95% CI [-1.2 to +1.4 d]).CONCLUSION: Gastrografin not only allowed early oralfeeding but also reduced the duration of hospitalizationafter elective colorectal surgery.

泛影葡胺在腹部手术后早期肠梗阻诊治中的应用效果

目的研究泛影葡胺在腹部手术后早期肠梗阻中的诊断价值,为需要手术干预肠梗阻手术时机的确定提供指导。方法对商洛市中心医院2015年10月至2017年10月收治的128例腹部手术后早期肠梗阻患者的临床资料进行回顾性分析,所有患者均采用泛影葡胺进行诊断,并根据诊断结果分析手术时机把握情况。结果98例应用泛影葡胺后经4~6h全程通过小肠显影,经过治疗后痊愈,无中转手术;14例应用泛影葡胺后历经12h缓慢通过回盲部,未发生小肠梗阻,经过治疗后痊愈;16例应用泛影葡胺后历经12~24h未见通过回盲部,需二次应用泛影葡胺,再观察6~12h后未见明显改善,为手术时机的选择提供了依据。结论泛影葡胺可对腹部手术后肠梗阻进行诊断性治疗,且对确定手术时机有很好的指导作用。

复方泛影葡胺灌肠治疗经腹会阴直肠切除术后炎性肠梗阻的临床疗效分析

目的探讨复方泛影葡胺灌肠治疗经腹会阴直肠切除术后炎性肠梗阻的临床疗效。方法选取2014年1月至2018年12月于大连大学附属新华医院收治的60例经腹会阴直肠切除术后炎性肠梗阻患者,按随机数字表法分为两组,各30例。两组均行一次性吸痰管经造口置入术,其中研究组选用复方泛影葡胺灌肠治疗,而对照组选用传统温皂水灌肠治疗,比较分析两组患者的临床主症的变化、腹部体征变化及影像学变化。结果两组患者接受非手术治疗后均成功痊愈;研究组腹痛/腹胀缓解时间、首次排气/排便时间、解除肠梗阻/临床治愈时间、影像学上消除肠管高度扩张/气液平面时间分别为(3.67±2.02)h、(2.20±1.86)h、(35.00±11.25)h、(32.93±11.20)h,均低于对照组(15.23±11.32)h、(11.47±7.56)h、(61.40±9.72)h、(58.60±9.48)h,差异均有统计学意义(均P<0.05);研究组临床疗效及预后显著优于对照组,差异均有统计学意义(均P<0.05);且两组无1例灌肠液不良反应。结论经腹会阴直肠切除术后炎性肠梗阻患者的复方泛影葡胺灌肠治疗,其操作方式安全且可行,临床疗效显著,值得临床推广应用。

Differences in examination results of small anastomotic fistula after radical gastrectomy with afterward treatments:A case report

BACKGROUND Gastrografin swallow,methylthioninium chloride test,and computed tomography(CT)are the main methods for postoperative anastomotic fistula detection.Correct selection and application of examinations and therapies are significant for the early diagnosis and treatment of small anastomotic fistulas after radical gastrectomy,which are conducive to postoperative recovery.CASE SUMMARY A 44-year-old woman underwent radical total gastrectomy for laparoscopic gastric cancer.The patient developed a fever after surgery.The methylthioninium chloride test and early CT suggested no anastomotic fistula,but gastrografin swallow and late CT showed the opposite result.The fistula was successfully closed using an endoscopic clip.The methylthioninium chloride test,gastrografin,and CT performed on different postoperative dates for small esophagojejunostomy fistulas are different.The size of the anastomotic fistula is an important factor for the success of endoscopic treatment.CONCLUSION The advantages and limitations of the diagnosis of different examinations of small esophagojejunostomy fistulas are noteworthy.The size of the leakage of the anastomosis is an important basis for selecting the repair method.

直肠癌根治术后复发的CT所见

本文报导35例直肠癌根治术后CT扫描结果,指出下列征象应考虑为复发的可靠证据1.尾骶椎前软组织包块2.尾骶前包块伴盆腔内器官或肌肉占位3.脊椎或盆骨溶骨性毁损4.盆腔内或后腹膜淋巴结转移5.肝脏、肺转移作者认为,对直肠癌术后患者定期进行盆腹腔CT扫描,有助于发现早期转移灶。

经口泛影葡胺对粘连性小肠不全梗阻疗效的前瞻性研究

目的 探讨泛影葡胺在急性粘连性小肠不全性梗阻的治疗作用，并与甘露醇及常规的保守治疗方法作前瞻性研究。方法 对１０９ 例急性粘连性小肠不全梗阻１１７ 例进行分析，随机将病人分成泛影葡胺组３７ 例４１次经胃管注入７６ ％ 泛影葡胺溶液１００ｍｌ，甘露醇组３５ 例３６ 次经胃管注入１０ ％ 甘露醇溶液２００ｍｌ，对照组３７ 例４０ 次一般保守治疗。观察肠梗阻缓解时间，手术及住院时间。结果 平均第一次排便时间Ｇ 组６－３ 小时，Ｍ 组１６－５ 小时，Ｃ组２７－３ 小时（Ｇ：Ｍ，Ｐ ＜ ０－０５ ；Ｂ：Ｃ， Ｐ＜ ０－０２ ；Ｇ：Ｃ， Ｐ ＜ ０－０１） 。Ｇ 组３ 次，Ｍ 组６ 次，Ｃ 组９ 次经治疗无效而手术，差异无统计学意义。各组对治疗有效平均住院时间分别为Ｇ 组２－９ 天，Ｍ 组３－７ 天，Ｃ 组４－５天（Ｇ：Ｃ， Ｐ＜ ０－０１） 。结论 经口泛影葡胺对急性小肠不全性梗阻是一种安全有效的治疗方法，较目前临床上采用的方法，它能明显缩短肠梗阻缓解及住院时间，同时还为早期手术提供线索。