Assalia A, Schein M, Kopelman D, Hirshberg A, Hashmonai M
Department of Surgery B, Rambam Medical Center, Haifa, Israel.
Surgery. 1994 Apr;115(4):433-7.
Previous published clinical observations claim that Gastrografin, a hyperosmolar gastrointestinal water-soluble contrast agent, speeds the resolution of postoperative ileus, barium impaction ileus, adhesive small-bowel obstruction, and intestinal obstruction caused by parasites and bezoars. However, no objective data exist that support the therapeutic effects of Gastrografin in these situations.
A total of 107 episodes of adhesive, partial small-bowel obstruction in 99 patients were randomized into a control group (48 episodes), who were treated with conventional methods, and a trial group (59 episodes), who were treated with 100 ml of Gastrografin administered through the nasogastric tube. The following variables were examined: time to resolution of partial small-bowel obstruction, the need for operation, complications, and hospital stay.
Mean timing of the first stool was 23.3 hours in the control group and 6.2 hours in the patients receiving Gastrografin (p < 0.00001). Ten obstructive episodes (21%) in the control group required operative treatment compared with six (10%) in the trial group (p = 0.12). Mean hospital stay for the patients who responded to conservative treatment was 4.4 days and 2.2 days in the control and trial groups, respectively (p < 0.00001). One patient in each group died after operation. No Gastrografin-related complications were observed.
Orally administered Gastrografin is safe and has a therapeutic role in adhesive, partial small-bowel obstruction. It significantly prompts the resolution of the obstructive episodes and shortens hospital stay. However, further studies are necessary to confirm the significance of our observation that it may reduce the need for operation.
先前发表的临床观察结果表明，高渗性胃肠道水溶性造影剂泛影葡胺可加快术后肠梗阻、钡剂嵌塞性肠梗阻、粘连性小肠梗阻以及由寄生虫和胃石引起的肠梗阻的缓解。然而，尚无客观数据支持泛影葡胺在这些情况下的治疗效果。
将99例患者共107次粘连性部分小肠梗阻发作随机分为对照组（48次发作），采用传统方法治疗；试验组（59次发作），通过鼻胃管给予100 ml泛影葡胺治疗。检查以下变量：部分小肠梗阻缓解时间、手术需求、并发症和住院时间。
对照组首次排便的平均时间为23.3小时，接受泛影葡胺治疗的患者为6.2小时（p < 0.00001）。对照组有10次梗阻发作（21%）需要手术治疗，而试验组为6次（10%）（p = 0.12）。对保守治疗有反应的患者，对照组和试验组的平均住院时间分别为4.4天和2.2天（p < 0.00001）。每组各有1例患者术后死亡。未观察到与泛影葡胺相关的并发症。
口服泛影葡胺是安全的，对粘连性部分小肠梗阻具有治疗作用。它能显著促进梗阻发作的缓解并缩短住院时间。然而，需要进一步研究来证实我们的观察结果，即它可能减少手术需求的意义。
