A Clinical Study Of Computed Tomography Urografin Enteroclysis In The Small Bowel Obstruction

Objective:1.To evaluate and compare the sensitivity,accuracy and specificity of co-mputed tomography urografin enteroclysis with multi slice spiral CT or oral urografinangiography in the diagnosis and treatment of intestinal obstruction;2.To study the cli-nical significance of the diagnosis of obstruction pathogeny and position by computedtomography urografin enteroclysis in small bowel obstruction;3.To investigate the us-age value of the computed tomography urografin enteroclysis in directing the treatme-nt-choice used in small-bowel obstruction.Materials and methods: According to inclusion criteria and exclusion criteria tochoose patients who are suspected as small intestinal obstruction by clinical and upri-ght abdominal X-ray film.219cases were randomly divided into3groups:computed t-omography urografin enteroclysis group (group A), CT scanning group (group B),me-glumine diatrizoate contrast X-ray group (group C).Group A includes76cases, groupB88cases,group C55cases.Before scanning by CT,group A will be injected80ml38%angiografin solution by stomach tube or takes38%angiografin solution,then closetube1-1.5hours and continuou gastrointestinal decompression.After24hours,this gr-roup will be scanned by CT. However,group B go straight into CT scanning without i-ntroducing contrast agent.Group C will be injected80ml38%angiografin soluteon bystomach tube or takes38%angiografin solution.After about0h,4h,8h,12h,16h,24h,itwill be scanned by X line to track and observe the contrast agent. All imaging datawill be analyzed by2doctors who have the experience of imaging diagnosis of deputychief physician.when they disagree with the opinion each other,differences will beresolved through discussion.Results:1.In group A, making a consistency analysis between whether the intestinalobstruction is complete or incomplete and whether to perform final surgical therapy o-n patients,the Kappa score is0.890.And the group B is0.327.Comparing the rate of c- orrect diagnosis and treatment between Group A and group B,P=0.000and the differe-nce is of significance in statistics science.So whether to perform final surgical therapyon patients by deciding the degree of small bowel obstruction,the rate of correct diag-agnosis and treatment of group A is higher.However, between GroupA and group C,t-he difference is not of significance in statistics science(P=0.700).2.Comparing the rateof correct diagnosis of obstruction position between group A and group B,χ2=7.759,P<0.05, between group C and group B,χ2=3.518, P<0.05.From the above results,the difference is statistically significant and the correct rate of group A and group C is hig-her than group B.3.Comparing the rate of correct diagnosis of obstruction cause betw-een group A and group B,there was no statistical significance(χ2=0.274,P>0.05).So group A and group B have the same advantage in the rate of correct diagnosis of obstr-uction cause.But comparing group A with group C or group B with group C,the differ-ence was statistically significant (P<0.05).In a word,the rate of correct diagnosis ofobstruction cause of group A and group B is better than group C.4.The rate of successconservative treatment of group A patients with adhesive intestinal obstruction was65.57%,group B43.33%,group C80.39%.Comparing the success rate between groupA and group B(P=0.011) or group C and group B(P=0.000),the difference had astatistically significant.Above all,group A and group C can improve the rate of successconservative treatment in the patients with adhesive intestinal obstruction;Comparingthe remission time after in hospital and days of hospitalization between group A andgroup B, the difference was statistically significant (P=0.005,P=0.001).So group A is avaluable way to accelerate the remission of the disease and reduce the hospitalizationdays.Conclusion:1.In judging the degree and position of obstruction of small bowel obs-truction,multi-slice spiral CT urografin enteroclysis is superior to CT plain.2.Determi-ning the cause of small bowel obstruction,multi-slice spiral CT urografin enteroclysisis better than Meglumine diatrizoate angiography.However,in the degree and positionof obstruction of small bowel obstruction,the advantages of both is quite.3.Multislicespiral CT urografin enteroclysis has effect on the treatment of adhesive intestinal obstruction patients and can improve the success rate of conservative treatment.Inaddition,it is beneficial to accelerate the remission of the disease and reduce thehospitalization days.4. Whether the contrast agent of multi-slice spiral CT urografinenteroclysis arrive at the colon during24h has some guidance significance for thechoice of conservative or surgical treatment of small bowel obstruction.