Nonoperative treatment efficacy prognosis in acute small bowell obstruction
Abstract
Aim of investigation. Objective is to optimize treatment strategy for patients presenting with acute small bowell obstruction (SBO) due to adhesions. We developed a prognostic scale for conservative treatment outcome utilizing multiple prognostic factors.
Methods. In retrospective study case records of 385 patients for 2003–2008 have been analyzed. Patients with suspicion to strangulation were not included in investigation. According to the designed integrated prognostic system with application of Bayesian statistical methods patients have been distributed into three prognostic groups. Patients with low chances for conservative resolution of obstruction underwent surgery, i.e. adhesiolysis. Standard conservative therapy was carried out to patients with high chances. Conservative treatment that included endoscopic nasointestinal decompression (ENID) was prescribed to patients from the group of peer probability of obstruction resolution. Results. Prognostic system has been tested in 2009. During observation time 56 patients with SBO were admitted to the clinic, of them 13 were operated urgently and 43 were included into prospective study. Favourable results of standard conservative treatment were received in 68,7% of the cases (11 of 16 patients), ENID was effective in all 15 patients of this group and 22 patients with low likelihood of conservative resolution have been operated. The over-all mortality was 2,2% (1 patient of 43).
Conclusion. The designed prognostic scale allows to prove with high accuracy the choice of SBO treatment method and to predict treatment outcome at this disease with high performance.
About the Authors
S. G. ShapovalyantsRussian Federation
S. Ye. Larichev
Russian Federation
Z. A. Zhemukhova
Russian Federation
N. A. Soldatova
Russian Federation
I. A. Smirnov
Russian Federation
References
1. Алиев С.А. Особенности диагностики и хирургической тактики при спаечной кишечной непроходимости // Хирургия. – 1994. – № 2. – С. 13–17.
2. Богданов А.Е. Острая кишечная непроходимость: пути улучшения результатов лечения: Дис. ... д-ра мед. наук. – М., 1999. – 277 с.
3. Дедерер Ю.М. Острая непроходимость кишечника // Клиническая хирургия: Справочное руководство для врачей / Под ред. Ю.М. Панцырева. – М.: Медицина, 1988. – С. 267–268.
4. Дедерер Ю.М. Патогенез и лечение острой непроходимости кишечника. – М.: Медицина, 1971. – 272 с.
5. Ермолов А.С., Лебедев А.Г., Утешев Н.С. О значении кишечной интубации при лечении тонкокишечной непроходимости // Назоинтестинальная интубация в неотложной хирурги: Материалы городского семинара НИИСП им. Н.В. Склифосовского. – М., 2003. – С. 11.
6. Ерюхин Е.А., Петров В.П., Ханевич М.Д. Кишечная непроходимость: Руководство для врачей. – СПб, 1999.
7. Жечневский Р.А. Спаечная болезнь. – М.: Медицина, 1989. – с 191.
8. Зайцев В.Т., Бритик В.И., Бутримов И.И., Щербаков В.И. Прогнозирование течения заболевания на основании клинических показателей у больных с острой кишечной непроходимостью: Тез. докл. Всесоюз. конф. по неотложной хирургии. – Ростов н/Д., 1991. – С. 52–53.
9. Крохалев А.А., Хорошко Н.В. О летальных исходах при острой кишечной непроходимости: Материалы 4-го Всерос. съезда хирургов. – Пермь, 1973. – С. 158– 160.
10. Курыгин А.А., Ханевич М.Д. Дренирование тонкой кишки и внутрикишечная детоксикация при кишечной непроходимости: Тез. докл. Первого конгресса ассоциации хирургов им. Н.И. Пирогова. – Ташкент, 1996. – С. 84–85.
11. Лебедев А.Г., Пахомова Г.В., Утешев Н.С. Декомпрессия желудочно-кишечного тракта при тонкокишечной непроходимости: Материалы науч.-практ. конф., посвященной 100-летию П.Л. Сельцовского. – М., 1998. – С. 53–59.
12. Мартынов Ю.А., Гончаров О.В., Штофин С.Г. Ранняя спаечная послеоперационная кишечная непроходимость: Материалы науч.-практ. конф. – Новосибирск, 1993. – С. 66–67.
13. Петров В.П., Ерюхин И.А. Кишечная непроходимость. – М.: Медицина, 1989. – 286 с.
14. Чернов В.Н., Белик Б.М. Выбор хирургической тактики и методов дезинтоксикации при острой непроходимости кишечника // Хирургия. – 1999. – № 5. – С. 45–47.
15. Abbas S.M., Bisset I.P., Parry B.R. Meta-analysis of oral water-soluble contrast agent in the management of adhesive small bowel obstruction // Br. J. Surg. – 2007. – Vol. 94. – P. 404–411.
16. Binenbaum S.J., Goldfarb M.A. Inadvertent enterotomy in minimally invasive abdominal surgery // JSLS. – 2006. – Vol. 10, N 3. – P. 336–340.
17. Foster N.M., McGory M.L., Zingmond D.S., Ko C.Y. Small bowel obstruction: a population-based appraisal // J. Am. Coll. Surg. – 2006. – Vol. 203. – P. 170–176.
18. Hata J., Kamada T., Haruma K., Kusunoki H. Evaluation of bowel ischemia with contrast-enhanced US: Initial experience // Radiology. – 2005. – Vol. 236. – P. 712–715.
19. Hok-Kwok Choi, Wai-Lun Law, Judy wi-Chu Ho, Kin-Wah Chu. Value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective evaluation // World J. Gastroenterol. – 2005. – Vol. 11, N 24. – P. 3742–3745.
20. Jean-Jaques Duron, Natalie Jourdan-Da Silva. Adhesive postoperative small bowel obstruction: incidence and risk factors of recurrence after surgical treatment // Ann. Surg. – 2006. – Vol. 244. – P. 750–757.
21. Kossi J., Salminen P., Laato M. The epidemiology and treatment patterns of postoperative adhesion induced intestinal obstruction in Varsinais-Suomi Hospital District // Scand. J. Surg. – 2004. – Vol. 93. – P. 68–72.
22. Kuremu R.T., Jumbi G. Adhesive intestinal obstruction // East Afr. Med. J. – 2006. – Vol. 83. – P. 333– 336.
23. Markogiannakis H., Messaris E., Dardamanis D. et al. Acute mechanical bowel obstruction: Clinical presentation, etiology, management and outcome // World J. Gastroenterol. – 2007. – Vol. 13, N 3. – P. 432–437.
24. Szomstein S., Lo Menzo E., Simpfendorfer C. et al. Laparoscopic lysis of adhesions // World J. Surg. – 2006. – Vol. 30. – P. 535–540.
25. Van der Krabben A.A., Dijkstra F.R. et al. Morbidity and mortality of inadvertent enterotomy during adhesiotomy // Br. J. Surg. – 2000. – Vol. 87, N 4. – P. 467–471.
26. Van Goor H. Consequences and complications of peritoneal adhesions // Colorectal Dis. – 2007. – Vol. 9 (suppl. 2). – P. 25–34.
27. Williams S.B., Greenspon J., Young H.A., Orkin B.A. Small bowel obstruction: conservative vs. surgical management // Dis. Colon Rectum. – 2005. – Vol. 48. – P. 1140–1146.
Review
For citations:
Shapovalyants S.G., Larichev S.Ye., Zhemukhova Z.A., Soldatova N.A., Smirnov I.A. Nonoperative treatment efficacy prognosis in acute small bowell obstruction. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2011;21(1):57-62. (In Russ.)
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