Chukwu Isaac S, Ekenze Sebastian O, Ezomike Uchechukwu O, Chukwubuike Kevin E, Ekpemo Samuel C
Sub-Department of Pediatric Surgery, University of Nigeria Teaching Hospital Ituku/Ozalla, Enugu, Nigeria.
Department of Surgery, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria.
Eur J Pediatr. 2023 Mar;182(3):1049-1056. doi: 10.1007/s00431-022-04765-5. Epub 2022 Dec 23.
Non-operative reduction has emerged as first line in the management of uncomplicated intussusception. The aim of this study was to compare the outcome of ultrasound-guided saline hydrostatic reduction and ultrasound-guided pneumatic reduction of intussusception in infants. This is a prospective study of infants with uncomplicated intussusception confirmed by ultrasound over a period of 21 months from December 2018 to August 2020. Fifty-two (69.3%) out of seventy-five infants were eligible and randomized based on simple random sampling technique into two groups: Group A included patients who had ultrasound-guided hydrostatic (saline) reduction; Group B included patients who had ultrasound-guided pneumatic (air) reduction. The success rates, time to reduction and complication rates were assessed. The success rates, between the saline hydrostatic reduction group and pneumatic reduction group, were comparable [17 (65.4%) versus 19 (73.1%); relative risk (RR) 0.8; 95% confidence interval (CI) 0.6-1.2; p = 0.54]. The mean time to reduction was higher in the saline hydrostatic reduction group (15.4 ± 5.1 min versus 10.8 ± 4.1 min; p = 0.003). There was no statistically significant difference in the perforation and recurrence rates between the two groups.
Saline hydrostatic reduction and pneumatic reduction of uncomplicated intussusception under ultrasound guidance in infants might have comparable outcomes. However, pneumatic reduction may be faster.
• Ileocolic intussusception is the most common cause of intestinal obstruction in infants. • Ultrasonography is useful in the diagnosis and non-operative treatment of ileocolic intussusception.
• Ultrasound-guided hydrostatic enema and ultrasound-guided pneumatic enema are similarly effective and safe techniques in the reduction of ileocolic intussusception. • Reduction of ileocolic intussusception under ultrasound guidance is a great technique that may prove useful in the developing world due to lower cost of required equipment.
非手术复位已成为单纯性肠套叠治疗的一线方法。本研究的目的是比较超声引导下生理盐水水压灌肠复位和超声引导下气体灌肠复位治疗婴儿肠套叠的效果。这是一项前瞻性研究，对2018年12月至2020年8月期间经超声确诊的单纯性肠套叠婴儿进行了为期21个月的观察。75名婴儿中有52名（69.3%）符合条件，并根据简单随机抽样技术随机分为两组：A组包括接受超声引导下生理盐水水压灌肠复位的患者；B组包括接受超声引导下气体灌肠复位的患者。评估了成功率、复位时间和并发症发生率。生理盐水水压灌肠复位组和气体灌肠复位组的成功率相当[17例（65.4%）对19例（73.1%）；相对危险度（RR）0.8；95%置信区间（CI）0.6 - 1.2；p = 0.54]。生理盐水水压灌肠复位组的平均复位时间更长（15.4 ± 5.1分钟对10.8 ± 4.1分钟；p = 0.003）。两组之间的穿孔率和复发率无统计学显著差异。
超声引导下婴儿单纯性肠套叠的生理盐水水压灌肠复位和气体灌肠复位可能效果相当。然而，气体灌肠复位可能更快。
• 回结肠型肠套叠是婴儿肠梗阻最常见的原因。• 超声检查在回结肠型肠套叠的诊断和非手术治疗中有用。
• 超声引导下的生理盐水灌肠和超声引导下的气体灌肠在回结肠型肠套叠复位中是同样有效和安全的技术。• 超声引导下的回结肠型肠套叠复位是一项很棒的技术，由于所需设备成本较低，可能在发展中国家证明有用。
