Haule Caspar, Ongom Peter A, Kimuli Timothy
Department of Surgery, School of Medicine, Makerere University College of Health Sciences, Makerere University, P O Box 7072, Kampala, Uganda.
J Clin Trials. 2013 Dec 1;3(4). doi: 10.4172/2167-0870.1000144.
The treatment of adhesive small bowel obstruction is controversial, with both operative and non-operative management practiced in different centers worldwide. Non-operative management is increasingly getting popular, though operative rates still remain high. A study to compare the efficacy of an oral water-soluble medium (Gastrografin) with standard conservative management, both non-operative methods, in the management of this condition was conducted in a tertiary Sub Saharan hospital.
An open randomised controlled clinical trial was conducted between September 2012 and March 2013 at Mulago National Referral and Teaching Hospital, Uganda. Fifty patients of both genders, with adhesive small bowel obstruction, in the hospital's emergency and general surgical wards were included. Randomisation was to Gastrografin and standard conservative treatment groups. The primary outcomes were: the time interval between admission and relief of obstruction, the length of hospital stay, and the rates of operative surgery.
All 50 recruited patients were followed up and analysed; 25 for each group. In the Gastrografin group, 22 (88%) patients had relief of obstruction following the intervention, with 3 (12%) requiring surgery. The conservative treatment group had 16 (64%) patients relieved of obstruction conservatively, and 9 (36%) required surgery. The difference in operative rates between the two groups was not statistically significance ( = ). Average time to relief of obstruction was shorter in the Gastrografin group (72.52 hrs) compared to the conservative treatment group (117.75 hrs), a significant difference ( = ). The average length of hospital stay was shorter in the Gastrografin group (5.62 days) compared to the conservative treatment group (10.88 days), a significant difference ( = ).
The use of Gastrografin in patients with adhesive small bowel obstruction helps in earlier resolution of obstruction and reduces the length of hospital stay compared with standard conservative management. Its role in reducing the rate of laparotomies remains inconclusive.
粘连性小肠梗阻的治疗存在争议，全球不同中心采用手术和非手术治疗方法。非手术治疗越来越受欢迎，尽管手术率仍然很高。在撒哈拉以南的一家三级医院进行了一项研究，比较口服水溶性介质（泛影葡胺）与标准保守治疗（两种非手术方法）在治疗这种疾病中的疗效。
2012年9月至2013年3月在乌干达穆拉戈国家转诊和教学医院进行了一项开放随机对照临床试验。纳入了该医院急诊和普通外科病房的50例患有粘连性小肠梗阻的男女患者。随机分为泛影葡胺组和标准保守治疗组。主要结局指标为：入院至梗阻缓解的时间间隔、住院时间和手术率。
所有50例招募患者均得到随访和分析；每组25例。泛影葡胺组中，22例（88%）患者在干预后梗阻缓解，3例（12%）需要手术。保守治疗组中，16例（64%）患者通过保守治疗梗阻缓解，9例（36%）需要手术。两组手术率的差异无统计学意义（=）。泛影葡胺组梗阻缓解的平均时间（72.52小时）短于保守治疗组（117.75小时），差异有统计学意义（=）。泛影葡胺组的平均住院时间（5.62天）短于保守治疗组（10.88天），差异有统计学意义（=）。
与标准保守治疗相比，在粘连性小肠梗阻患者中使用泛影葡胺有助于更早地缓解梗阻并缩短住院时间。其在降低剖腹手术率方面的作用仍不确定。
