Ito Yasuo, Kusakawa Isao, Murata Yuji, Ukiyama Etsuji, Kawase Hirokazu, Kamagata Shoichiro, Ueno Shigeru, Osamura Toshio, Kubo Minoru, Yoshida Masahiro
Guideline Committee of Japanese Society of Emergency Pediatrics, Department of Pediatric Surgery, International University of Health and Welfare, Atami Hospital, Atami, Japan.
Pediatr Int. 2012 Dec;54(6):948-58. doi: 10.1111/j.1442-200X.2012.03622_1.x. Epub 2012 Jul 2.
The Japanese Society of Emergency Pediatrics has formulated evidence-based guidelines for the management of intussusception in children in order to diagnose intussusceptions promptly, to initiate appropriate treatment as early as possible, and to protect intussuscepted children from death.
Literature was collected systematically via the Internet using the key words "intussusception" and "children." The evidence level of each paper was rated in accordance with the levels of evidence of the Oxford Center for Evidence-based Medicine. The guidelines consisted of 50 clinical questions and the answers. Grades of recommendation were added to the procedures recommended on the basis of the strength of evidence levels.
Three criteria of "diagnostic criteria,""severity assessment criteria," and "criteria for patient transfer" were proposed aiming at an early diagnosis, selection of appropriate treatment, and patient transfer for referral to a tertiary hospital in severe cases. Barium is no longer recommended for enema reduction (recommendation D) because the patient becomes severely ill once perforation occurs. Use of other contrast media, such as water-soluble iodinated contrast, normal saline, or air, is recommended under either fluoroscopic or sonographic guidance. Delayed repeat enema improves reduction success rate, and is recommended if the initial enema partially reduced the intussusception and if the patient condition is stable.
The guidelines offer standards of management, but it is not necessarily the purpose of the guidelines to regulate clinical practices. One should judge each individual clinical situation in accordance with experiences, available devices, and the patient's condition.
日本急诊儿科学会制定了儿童肠套叠管理的循证指南，以便及时诊断肠套叠，尽早开始适当治疗，并保护患肠套叠的儿童免于死亡。
通过互联网使用关键词“肠套叠”和“儿童”系统收集文献。每篇论文的证据水平根据牛津循证医学中心的证据水平进行评级。该指南由50个临床问题及答案组成。根据证据水平的强度，在推荐的程序中增加了推荐等级。
提出了“诊断标准”“严重程度评估标准”和“患者转诊标准”三个标准，旨在早期诊断、选择适当治疗以及在严重病例中转诊至三级医院。不再推荐使用钡剂灌肠复位（推荐等级D），因为一旦发生穿孔，患者病情会严重恶化。建议在透视或超声引导下使用其他造影剂，如水溶性碘化造影剂、生理盐水或空气。延迟重复灌肠可提高复位成功率，若初始灌肠使肠套叠部分复位且患者病情稳定，则推荐使用。
该指南提供了管理标准，但规范临床实践不一定是指南的目的。应根据经验、可用设备和患者情况判断每个具体的临床情况。
