超过 48 小时病史的小儿肠套叠灌肠复位是否安全：一项回顾性队列研究。
Is enema reduction in pediatric intussusception with a history of over 48 h safe: A retrospective cohort study.
机构信息
Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, PR China.
Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, PR China.
出版信息
Am J Emerg Med. 2023 Jun;68:33-37. doi: 10.1016/j.ajem.2023.02.027. Epub 2023 Mar 5.
BACKGROUND
Intussusception is one of the most common acute abdominal diseases in children. Enema reduction is the first-line treatment for intussusception in good condition. Clinically, a history of disease over 48 h is usually listed as a contraindication for enema reduction. However, with the development of clinical experience and therapy, an increasing number of cases have shown that the prolongation of the clinical course of intussusception in children is not an absolute contraindication for enema treatment. This study aimed to analyze the safety and efficacy of enema reduction in children with a history of disease longer than 48 h.
METHODS
We conducted a retrospective matched-pair cohort study of pediatric patients with acute intussusception between 2017 and 2021. All patients were treated with ultrasound-guided hydrostatic enema reduction. According to the length of history, the cases were classified into two groups: history <48 h (<48 h group) and history greater than or equal to 48 h (≧48 h group). We generated a 1:1 matched-pair cohort matched for sex, age, admission time, main symptoms, and concentric circle size on ultrasound. Clinical outcomes were compared between the two groups, including success, recurrence, and perforation rates.
RESULTS
From January 2016 to November 2021, 2701 patients with intussusception were admitted to the Shengjing Hospital of China Medical University. A total of 494 cases were included in the ≧48 h group, and 494 cases with a history of <48 h were selected for matched comparison in the <48 h group. The success rates of the ≧48 h and <48 h groups were 98.18% vs. 97.37% (p = 0.388), and the recurrence rates were 13.36% vs. 11.94% (p = 0.635), showing no difference according to the length of history. The perforation rate was 0.61% vs. 0%, respectively, with no significant difference (p = 0.247).The comparison of the different history groups showed that in patients with bloody stools, the length of history had no significant effect on the enema reduction outcome(94.90% vs. 86.76%, p = 0.064).
CONCLUSIONS
Ultrasound-guided hydrostatic enema reduction is safe and effective for pediatric idiopathic intussusception with a history of ≧48 h.
背景
肠套叠是儿童最常见的急性腹部疾病之一。灌肠复位是肠套叠良好条件下的一线治疗方法。临床上，通常将疾病史超过 48 小时列为灌肠复位的禁忌症。然而，随着临床经验和治疗方法的发展，越来越多的病例表明，儿童肠套叠的临床病程延长并不是肠套叠治疗的绝对禁忌症。本研究旨在分析病史超过 48 小时的儿童进行灌肠复位的安全性和有效性。
方法
我们对 2017 年至 2021 年期间收治的小儿急性肠套叠患者进行了回顾性配对病例对照队列研究。所有患者均采用超声引导水压灌肠复位治疗。根据病史长短，病例分为两组：病史<48 小时(<48 h 组)和病史大于或等于 48 小时(≧48 h 组)。我们按照性别、年龄、入院时间、主要症状和超声同心圆大小进行了 1:1 配对病例对照。比较两组的临床结局，包括成功率、复发率和穿孔率。
结果
2016 年 1 月至 2021 年 11 月，中国医科大学盛京医院收治肠套叠患儿 2701 例。≧48 h 组共纳入 494 例，<48 h 组选择 494 例与之匹配。≧48 h 组和<48 h 组的成功率分别为 98.18%比 97.37%(p=0.388)，复发率分别为 13.36%比 11.94%(p=0.635)，按病史长短无差异。穿孔率分别为 0.61%和 0%，无显著性差异(p=0.247)。不同病史组比较显示，血便患儿的病史长短对灌肠复位效果无显著影响(94.90%比 86.76%，p=0.064)。
结论
超声引导水压灌肠复位治疗病史≧48 h 的小儿特发性肠套叠安全有效。
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