Hamid Raashid, Bhat Nisar, Baba Aejaz, Mufti Gowhar, Khursheed Sheikh, Wani Sajad A, Ali Imran, Hassan Faheem
Department of Paediatric and Neonatal Surgery, Skims, Srinager, Jammu and Kashmir, India.
Pediatr Surg Int. 2015 Dec;31(12):1171-6. doi: 10.1007/s00383-015-3793-x. Epub 2015 Oct 1.
Ascaris-induced small bowel obstruction (SBO) is a common sequel of Ascaris lumbricoides (AL) infestation. Most cases respond to conservative treatment practiced in different centers worldwide. We conceived a prospective randomized trial to compare the conservative treatment with gastrografin administered in addition to the conservative treatment.
This prospective randomized study was conducted between January 2011 and June 2014 at Department of Paediatric and Neonatal Surgery, a tertiary-care hospital. Patients were divided into two groups, one group received conservative treatment and the other received gastrografin in addition to conservative treatment. Forty patients having uncomplicated AL-induced SBO were included in each group. Gastrografin was administered through nasogastric tube and serial clinical and radiological monitoring was performed. The duration of hospital stay, time between admission and first oral feed, passage of worms/flatus were compared in the two groups. Student's t test was used for comparing these variables.
Average time for passage of flatus or worms and resolution of abdominal signs and was shorter in gastrografin group as compared to the conservative group. This difference was found to be statistically significant. The average duration of hospital stay in gastrografin group was 25.20 ± 8.01 h whereas it was 61.12 ± 14.64 h in the conservative group (P < 0.001). The difference in the operation rate was statistically insignificant (2 in gastrografin group and 3 in the conservative group).No serious adverse reaction was noted after gastrografin administration.
Use of gastrografin resulted in faster relief of signs and symptoms of AL-induced SBO, early passage of worms/flatus and return to oral feeds. However, the role of gastrografin role in reducing the likelihood of laparotomy remains inconclusive. Adverse effects of gastrografin can be prevented if it is used in well-hydrated patients.
蛔虫引起的小肠梗阻（SBO）是蛔虫感染的常见后遗症。全球不同中心采用的保守治疗对大多数病例有效。我们开展了一项前瞻性随机试验，比较保守治疗与在保守治疗基础上加用泛影葡胺的疗效。
这项前瞻性随机研究于2011年1月至2014年6月在一家三级护理医院的儿科和新生儿外科进行。患者分为两组，一组接受保守治疗，另一组在保守治疗基础上加用泛影葡胺。每组纳入40例无并发症的蛔虫引起的小肠梗阻患者。通过鼻胃管给予泛影葡胺，并进行连续的临床和影像学监测。比较两组的住院时间、入院至首次经口进食的时间、蛔虫/气体排出时间。采用学生t检验比较这些变量。
与保守治疗组相比，泛影葡胺组气体或蛔虫排出以及腹部体征消失所需的平均时间更短。发现这种差异具有统计学意义。泛影葡胺组的平均住院时间为25.20±8.01小时，而保守治疗组为61.12±14.64小时（P<0.001）。手术率的差异无统计学意义（泛影葡胺组2例，保守治疗组3例）。给予泛影葡胺后未观察到严重不良反应。
使用泛影葡胺可更快缓解蛔虫引起的小肠梗阻的体征和症状，使蛔虫/气体更早排出并恢复经口进食。然而，泛影葡胺在降低剖腹手术可能性方面的作用仍不确定。如果在充分补液的患者中使用泛影葡胺，可预防其不良反应。
