Li Huan,Wang Xin,Yang Hu,et al.Ultrasound-guided hydrostatic reduction versus fluoroscopy-guided air reduction for pediatric primary intussusception: a single-center retrospective study of 949 cases[J].Journal of Clinical Pediatric Surgery,2023,22(10):988-991.[doi:10.3760/cma.j.cn101785-202203072-016]
水压灌肠与空气灌肠复位治疗小儿原发性肠套叠单中心949例回顾性研究
- Title:
- Ultrasound-guided hydrostatic reduction versus fluoroscopy-guided air reduction for pediatric primary intussusception: a single-center retrospective study of 949 cases
- Keywords:
- Intussusception; Enema; Treatment Outcome; Child
- 摘要:
- 目的 探讨水压灌肠与空气灌肠复位治疗小儿原发性肠套叠的有效性和安全性。方法 本研究为单中心回顾性研究。以2019年7月至2020年12月华中科技大学同济医学院附属武汉儿童医院收治的949例原发性肠套叠患儿为研究对象,根据复位方法分为超声监视下水压灌肠复位组(471例)和X线引导下空气灌肠复位组(478例)。比较两组患儿性别、年龄、发病时间、复位时间、复位成功率、肠穿孔发生率以及复发率情况。结果 两组患儿性别、年龄和发病时间等一般资料差异无统计学意义(P>0.05);水压灌肠组复位成功率(463/471,98.3%)高于空气灌肠组(449/478,93.9%),差异有统计学意义(P＜0.05);发病时间48 h以内的患儿中,水压灌肠组复位成功率(388/396,98.0%)高于空气灌肠组(373/400,93.3%),差异有统计学意义(P＜0.05);年龄1岁以内患儿中,水压灌肠组复位成功率(117/121,96.7%)高于空气灌肠组(102/123,82.9%),差异有统计学意义(P＜0.05)。结论 对于年龄1岁以下、发病时间小于48 h的肠套叠患儿,超声监视下水压灌肠复位的疗效优于X线引导下空气灌肠复位,可作为肠套叠的首选治疗方法。
- Abstract:
- Objective To compare the efficacy and safety of ultrasound-guided hydrostatic reduction (UGHR) versus fluoroscopy-guided air reduction (FGAR) for primary intussusception in children.Methods A single-center retrospective analysis was performed for 949 children with primary intussusception from July 2019 to December 2020.According to the reduction approaches,they were assigned into two groups of UGHR (n=471) and FGAR (n=478).Gender,age,onset time,reduction success rate,perforation rate,recurrence rate and reduction time of two groups were compared.Results No significant inter-group differences existed in gender,age or onset time (P>0.05).Reduction success rate of UGHR group was higher than that of FGAR group (98.3% vs.93.9%)(P<0.05).In children with onset time <48 h,reduction success rate of UGHR group was higher than that of FGAR group (98.0% vs.93.3%)(P<0.05).In children aged <1 year,reduction success rate was significantly higher in UGHR group than that in FGAR group (96.7% vs.82.9%)(P<0.05).Conclusion In children with onset time <48 h and age <1 year,the efficacy of UGHR is better than that of FGAR.Thus UGHR is a preferred treatment for intussusception.
参考文献/References:
[1] Mandeville K,Chien M,Willyerd FA,et al.Intussusception:clinical presentations and imaging characteristics[J].Pediatr Emerg Care,2012,28(9):842-844.DOI:10.1097/PEC.0b013e318267a75e.
[2] 胡思佳,白玉作.空气灌肠复位与水压灌肠复位治疗小儿肠套叠研究进展[J].临床小儿外科杂志,2018,17(1):66-72.DOI:10.3969/j.issn.1671-6353.2018.01.016.Hu SJ,Bai YZ.Research advances in treating pediatric intussusception with air versus hydrostatic enema reduction[J].J Clin Ped Sur,2018,17(1):66-72.DOI:10.3969/j.issn.1671-6353.2018.01.016.
[3] Ondhia MN,Al-Mutawa Y,Harave S,et al.Intussusception:a 14-year experience at a UK tertiary referral centre[J].J Pediatr Surg,2020,55(8):1570-1573.DOI:10.1016/j.jpedsurg.2019.07.022.
[4] Stein-Wexler R,O’Connor R,Daldrup-Link H,et al.Current methods for reducing intussusception:survey results[J].Pediatr Radiol,2015,45(5):667-674.DOI:10.1007/s00247-014-3214-7.
[5] Tang XB,Zhao JY,Bai YZ.Status survey on enema reduction of paediatric intussusception in China[J].J Int Med Res,2019,47(2):859-866.DOI:10.1177/0300060518814120.
[6] Liu ST,Tang XB,Li H,et al.Ultrasound-guided hydrostatic reduction versus fluoroscopy-guided air reduction for pediatric intussusception:a multi-center,prospective,cohort study[J].World J Emerg Surg,2021,16(1):3.DOI:10.1186/s13017-020-00346-9.
[7] Edwards EA,Pigg N,Courtier J,et al.Intussusception:past,present and future[J].Pediatr Radiol,2017,47(9):1101-1108.DOI:10.1007/s00247-017-3878-x.
[8] Lampl BS,Glaab J,Ayyala RS,et al.Is intussusception a middle-of-the-night emergency?[J].Pediatr Emerg Care,2019,35(10):684-686.DOI:10.1097/PEC.0000000000001246.
[9] Flaum V,Schneider A,Gomes Ferreira C,et al.Twenty years’ experience for reduction of ileocolic intussusceptions by saline enema under sonography control[J].J Pediatr Surg,2016,51(1):179-182.DOI:10.1016/j.jpedsurg.2015.09.022.
[10] 蔡威,孙宁,魏光辉.肠套叠[M]//蔡威,孙宁,魏光辉.小儿外科学.北京:人民卫生出版社,2014:311.Cai W,Sun N,Wei GH.Intussusception[M]//Cai W,Sun N,Wei GH.Pediatric Surgery.Beijing:People’s Medical Publishing House,2014:311.
[11] Xie XL,Wu Y,Wang Q,et al.A randomized trial of pneumatic reduction versus hydrostatic reduction for intussusception in pediatric patients[J].J Pediatr Surg,2018,53(8):1464-1468.DOI:10.1016/j.jpedsurg.2017.08.005.
[12] Ito Y,Kusakawa I,Murata Y,et al.Japanese guidelines for the management of intussusception in children,2011[J].Pediatr Int,2012,54(6):948-958.DOI:10.1111/j.1442-200X.2012.03622_1.x.
[13] Abalo KD,Rage E,Leuraud K,et al.Early life ionizing radiation exposure and cancer risks:systematic review and meta-analysis[J].Pediatr Radiol,2021,51(1):45-56.DOI:10.1007/s00247-020-04803-0.
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备注/Memo
收稿日期:2022-3-23。
基金项目:武汉儿童医院临床医学科研项目(2021FE014)
通讯作者:杨俊,Email:yang12391@tom.com