超声引导下新型水灌肠仪器灌肠与传统空气灌肠治疗小儿肠套叠的有效性及安全性研究
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摘要
背景传统的X线引导下的空气灌肠治疗肠套叠存在较大的辐射,且有较大穿孔风险。目的探讨超声引导下新型水灌肠仪器灌肠与传统空气灌肠在小儿肠套叠治疗中的有效性及安全性。方法选取2016-05-10至2016-08-02于重庆医科大学附属儿童医院就诊,且符合纳入标准的原发性肠套叠患儿60例。使用电脑产生的随机数将其分为水灌肠组及空气灌肠组,各30例。水灌肠组使用超声引导下水灌肠仪器灌肠,空气灌肠组使用传统空气灌肠。观察记录两组患儿的复位成功率、复发率、复位时间及灌肠压力。结果两组复位成功率、复发率比较,差异无统计学意义(P>0.05)。水灌肠组复位时间长于空气灌肠组,灌肠压力高于空气灌肠组(P<0.001)。两组均没有肠穿孔及迟发型肠坏死发生。结论超声引导下新型水灌肠仪器灌肠治疗小儿肠套叠的复位成功率及复发率与传统空气灌肠无统计学差异,其复位时间较空气灌肠长,压力也更大,但是由于其压力可控等优点,仍值得推广使用。
Background The conventional pneumatic reduction of an intussusception is associated with a risk of perforation and considerable ionizing radiations.Objective To compare efficacy and safety of new ultrasound-guided hydrostatic reduction and conventional pneumatic reduction in treating pediatric intussusception.Methods A total of 60 patients with primary intussusception meeting inclusion criteria admitted to Children's Hospital of Chongqing Medical University from 10 May 2016 to 2 August 2016 were enrolled.Subjects were divided into hydrostatic reduction group and pneumatic reduction group by random numbers generated by computers,each with 30 patients.The pneumatic reduction group received new ultrasoundguided hydrostatic reduction,and the hydrostatic reduction group received conventional pneumatic reduction.The success rate of reduction,rate of recurrence,duration of reduction,and enema pressure were recorded.Results No significantly statistical differences were found in terms of success rate of reduction and recurrence rate between the two groups(P>0.05).The duration of reduction in hydrostatic reduction group was significantly longer than that in pneumatic reduction group,and the enema pressure in hydrostatic reduction group was significantly higher than that in pneumatic reduction group(P<0.001).No perforation and delayed intestinal necrosis were found in two groups. Conclusion The new ultrasound-guided hydrostatic reduction and conventional pneumatic reduction have similar success rate of reduction and recurrence rate in the treatment of pediatric intussusception.The new ultrasound-guided hydrostatic reduction is of great use of value as its pressure is controllable,although it has longer duration of reduction and higher enema pressure.
Background The conventional pneumatic reduction of an intussusception is associated with a risk of perforation and considerable ionizing radiations.Objective To compare efficacy and safety of new ultrasound-guided hydrostatic reduction and conventional pneumatic reduction in treating pediatric intussusception.Methods A total of 60 patients with primary intussusception meeting inclusion criteria admitted to Children's Hospital of Chongqing Medical University from 10 May 2016 to 2 August 2016 were enrolled.Subjects were divided into hydrostatic reduction group and pneumatic reduction group by random numbers generated by computers,each with 30 patients.The pneumatic reduction group received new ultrasoundguided hydrostatic reduction,and the hydrostatic reduction group received conventional pneumatic reduction.The success rate of reduction,rate of recurrence,duration of reduction,and enema pressure were recorded.Results No significantly statistical differences were found in terms of success rate of reduction and recurrence rate between the two groups(P>0.05).The duration of reduction in hydrostatic reduction group was significantly longer than that in pneumatic reduction group,and the enema pressure in hydrostatic reduction group was significantly higher than that in pneumatic reduction group(P<0.001).No perforation and delayed intestinal necrosis were found in two groups. Conclusion The new ultrasound-guided hydrostatic reduction and conventional pneumatic reduction have similar success rate of reduction and recurrence rate in the treatment of pediatric intussusception.The new ultrasound-guided hydrostatic reduction is of great use of value as its pressure is controllable,although it has longer duration of reduction and higher enema pressure.
引文
[1]KHORANA J,SINGHAVEJSAKUL J,UKARAPOL N,et al.Prognostic indicators for failed nonsurgical reduction of intussusception[J].Ther Clin Risk Manag,2016,12:1231-1237.DOI:10.2147/TCRM.S109785.
[2]BERES A L,BAIRD R.An institutional analysis and systematic review with meta-analysis of pneumatic versus hydrostatic reduction for pediatric intussusception[J].Surgery,2013,154(2):328-334.DOI:10.1016/j.surg.2013.04.036.
[3]MANDEVILLE K,CHIEN M,WILLYERD F A,et al.Intussusception:clinical presentations and imaging characteristics[J].Pediatr Emerg Care,2012,28(9):842-844.DOI:10.1097/PEC.0b013e318267a75e.
[4]XIE X,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.
[5]BINES J E,LIEM N T,JUSTICE F A,et al.Risk factors for intussusception in infants in Vietnam and Australia:adenovirus implicated,but not rotavirus[J].J Pediatr,2006,149(4):452-460.DOI:10.1016/j.jpeds.2006.04.010.
[6]KWON S R,HA S O,OH Y T,et al.Air reduction of intussusception after abdominal blunt trauma and a literature review[J].Clin Exp Emerg Med,2016,3(1):59-62.DOI:10.15441/ceem.15.014.
[7]LU S J,GOH P S.Traumatic intussusception with intramural haematoma[J].Pediatr Radiol,2009,39(4):403-405.
[8]ERICHSEN D,SELLSTR?M H,ANDERSSON H.Small bowel intussusception after blunt abdominal trauma in a 6-year-old boy:case report and review of 6 cases reported in the literature[J].J Pediatr Surg,2006,41(11):1930-1932.DOI:10.1016/j.jpedsurg.2006.06.004.
[9]KRISHNAKUM A R,HAMEED S,UMAMAHESHWARI.Ultrasound guided hydrostatic reduction in the management of intussusception[J].Indian J Pediatr,2006,73(3):217-220.DOI:10.1007/BF02825484.
[10]SORANTIN E,LINDBICHLER F.Management of intussusception[J].Eur Radiol,2004,14 Suppl 4:L146-154.DOI:10.1007/s00330-003-2033-2.
[11]DIGANT S M,RUCHA S,EKE D.Ultrasound guided reduction of an ileocolic intussusception by a hydrostatic method by using normal saline enema in paediatric patients:a study of 30 cases[J].JClin Diagn Res,2012,6(10):1722-1725.
[2]BERES A L,BAIRD R.An institutional analysis and systematic review with meta-analysis of pneumatic versus hydrostatic reduction for pediatric intussusception[J].Surgery,2013,154(2):328-334.DOI:10.1016/j.surg.2013.04.036.
[3]MANDEVILLE K,CHIEN M,WILLYERD F A,et al.Intussusception:clinical presentations and imaging characteristics[J].Pediatr Emerg Care,2012,28(9):842-844.DOI:10.1097/PEC.0b013e318267a75e.
[4]XIE X,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.
[5]BINES J E,LIEM N T,JUSTICE F A,et al.Risk factors for intussusception in infants in Vietnam and Australia:adenovirus implicated,but not rotavirus[J].J Pediatr,2006,149(4):452-460.DOI:10.1016/j.jpeds.2006.04.010.
[6]KWON S R,HA S O,OH Y T,et al.Air reduction of intussusception after abdominal blunt trauma and a literature review[J].Clin Exp Emerg Med,2016,3(1):59-62.DOI:10.15441/ceem.15.014.
[7]LU S J,GOH P S.Traumatic intussusception with intramural haematoma[J].Pediatr Radiol,2009,39(4):403-405.
[8]ERICHSEN D,SELLSTR?M H,ANDERSSON H.Small bowel intussusception after blunt abdominal trauma in a 6-year-old boy:case report and review of 6 cases reported in the literature[J].J Pediatr Surg,2006,41(11):1930-1932.DOI:10.1016/j.jpedsurg.2006.06.004.
[9]KRISHNAKUM A R,HAMEED S,UMAMAHESHWARI.Ultrasound guided hydrostatic reduction in the management of intussusception[J].Indian J Pediatr,2006,73(3):217-220.DOI:10.1007/BF02825484.
[10]SORANTIN E,LINDBICHLER F.Management of intussusception[J].Eur Radiol,2004,14 Suppl 4:L146-154.DOI:10.1007/s00330-003-2033-2.
[11]DIGANT S M,RUCHA S,EKE D.Ultrasound guided reduction of an ileocolic intussusception by a hydrostatic method by using normal saline enema in paediatric patients:a study of 30 cases[J].JClin Diagn Res,2012,6(10):1722-1725.