Arkansas Children's Hospital, Little Rock, AR 72202-3591, USA.
J Pediatr Surg. 2009 Nov;44(11):2130-2. doi: 10.1016/j.jpedsurg.2009.06.005.
Contrast enema is the initial study of choice for simple meconium ileus to confirm diagnosis and to relieve obstruction. Despite favorable historically published results, our clinical impression suggests decreased effectiveness of the contrast enema resulting in more surgical interventions in contemporary practice.
A retrospective multiinstitutional review for a 12-year period was conducted for neonates diagnosed with meconium ileus by contrast enema. The neonates were divided into 2 groups-historic group (HG = before 2002) and contemporary group (CG = after 2002). T test was used for comparison of continuous variables and chi(2) for categorical data.
Thirty-seven total patients were identified (21 females and 16 males). Obstruction was relieved in 8 neonates (22% overall success rate). Average enema attempt per patient was decreased in the CG group compared to HG (1.4 vs 1.9). The success rate in the CG group was 5.5% (1/18) compared to 39% (7/18) in HG.
In this review, success of contrast enema for relief of meconium ileus has significantly decreased over time. These findings may be because of reluctance to repeat enemas, change in radiologist experience, or use of contrast agent. As a result, higher rates of operative intervention are now observed. In stable patients, surgeons should recommend repeat enemas before exploration.
对比灌肠是单纯性胎粪性肠梗阻的首选初始研究方法，以确认诊断并缓解梗阻。尽管历史上发表的结果良好，但我们的临床印象表明，对比灌肠的效果降低，导致当代实践中更多的手术干预。
对经对比灌肠诊断为胎粪性肠梗阻的新生儿进行了为期 12 年的回顾性多机构研究。将新生儿分为 2 组-历史组（HG=2002 年前）和当代组（CG=2002 年后）。采用 t 检验比较连续变量，采用卡方检验比较分类数据。
共确定 37 例患儿（女性 21 例，男性 16 例）。8 例新生儿梗阻缓解（总体成功率 22%）。与 HG 相比，CG 组每个患儿的灌肠尝试次数减少（1.4 次 vs 1.9 次）。CG 组的成功率为 5.5%（1/18），HG 组为 39%（7/18）。
在本回顾性研究中，对比灌肠缓解胎粪性肠梗阻的成功率随时间显著降低。这些发现可能是由于不愿意重复灌肠、放射科医生经验的改变或造影剂的使用。因此，现在观察到更高的手术干预率。对于稳定的患者，外科医生应在探查前建议重复灌肠。
