1.1 General information The patients were selected from the department of Pediatric and Vascular Surgery of Weihai Municipal Hospital from January 2020 to August 2021, and were diagnosed by ultrasound[6]for children with intussusception. The children were included into the USGSE group or the air enema group.
Inclusion criteria :(1) primary intussusception with onset time < 48 h and good general condition; (2) The onset time was 48-72 hours, the general condition was good without multiple blood stools, and the hemodynamics was stable; (3) No signs of peritonitis on physical examination; (4) No enema contraindications.
Exclusion criteria :(1) onset time was more than 72 h; (2) The onset time was 48 ~ 72 h, accompanied by multiple blood stools, hemodynamic instability and intolerance to enema; (3) The course of the disease is less than 48 hours, but the general condition is significantly bad, such as severe dehydration (significantly increased heart rate, decreased urine volume, crying without tears, etc.), listlessness, high fever or shock, etc.; (4) High abdominal distension, obvious abdominal tenderness, muscle tension, suspected peritonitis or abdominal vertical X-ray suggested the possibility of digestive tract perforation; (5) There was a history of intussusception for several times (≥3 times) and family members were willing to perform surgical exploration; (6) repeated intussusception, highly suspected or diagnosed as secondary intussusception; (7) intestinal intussusception; (8) B-ultrasound clearly indicated the presence of gastrointestinal malformation or intestinal polyp; (9) Intussusception in infants under 3 months of age.
A total of 134 children with intussusception were admitted to the Department of Pediatric and Vascular Surgery of Weihai Municipal Hospital from January 2020 to August 2021, 104 of whom met the inclusion criteria. Among them, the parents of 24 patients refused to participate in this study, and 40 patients were sequentially included in the USGSE group and 40 patients in the air cla group, a total of 80 children. The average age was 13.35±8.72 months, the average weight was (9.66±2.22) kg, and the average course of disease was (33.14±20.05) h. The incidence of symptoms in the total samples was abdominal pain/parturient crying in 55 cases (68.8%), abdominal mass in 29 cases (36.3%), vomiting in 62 cases (77.5%), hematochezia in 24 cases (30.0%), diarrhea in 16 cases (20.0%), constipation in 13 cases (16.3%), abdominal distension in 17 cases (21.3%), respectively. The mean body temperature was (37.59±0.75) ℃, and the mean white blood cell count was (11599.15±4270.84) ×109 /L, The mean percentage of neutrophils was (51.53±19.25) %, The median follow-up time was 12 months (range: 6-15 months). The comparison of demographic and pre-treatment data between the two groups is shown in Table 1.
Table 1. Comparison of general data of children with intussusception with different treatment methods
|
|
USGSE Group (n=40)
|
Air enema group (n=40)
|
P value
|
Age, month
|
13.68±10.01
|
13.03±7.33
|
0.741
|
Weight, kg
Time of onset, H
|
9.64±2.34
|
9.67±2.13
|
0.960
|
32.1±20.91
|
34.18±19.36
|
0.646
|
Gender, %
|
|
|
|
male
|
29(72.5%)
|
27(67.5%)
|
0.626
|
maidenly
|
11(27.5%)
|
13(32.5%)
|
Symptoms, %
|
|
|
|
Abdominal pain/bursts of crying
|
29(72.5%)
|
26(65.0%)
|
0.469
|
Abdominal mass
|
13(32.5%)
|
16(40.0%)
|
0.485
|
Vomit up
|
33(82.5%)
|
29(72.5%)
|
0.284
|
Blood in stool
|
13(32.5%)
|
11(27.5%)
|
0.626
|
Abdominal distension
|
7(17.5%)
|
10(25.0%)
|
0.412
|
diarrhea
|
9(22.5%)
|
7(17.5%)
|
0.576
|
constipation
|
8(20.0%)
|
5(12.5%)
|
0.363
|
Body temperature, ℃
|
37.60±0.76
|
37.59±0.74
|
0.964
|
White blood cell count, times 109PCS /L
|
11903.60±4326.51
|
11294.70±4247.24
|
0.527
|
The percentage of neutrophils, %
|
53.90±18.17
|
49.16±20.22
|
0.273
|
1.2 Methods USGSE group: atropine was intramuscular injected 0.01 mg/kg for 30 min[7], the child was placed in supine position, the Foley catheter of the appropriate type (10F ~ 22F) was inserted into the rectum, and 10-30ml saline was injected into the balloon.The warm salt water preheated to 37 ℃ was hung 100 cm above the enema plane[8], adjust the enema pressure by adjusting the suspension height, up to 120 cmH2O (Control the initial enema pressure to 80 cmH2O for children younger than 6 months. 1cmH20=0.098kPa, 1mmH2O=0.00981kPa)[5]. Under ultrasonic monitoring, warm saline was retrograde into the colon and kept for 3-5 min at an interval < 3 min. If 1L warm saline was still not completely reduced, the saline was drained and this process was repeated for up to 3 times. The changes of the injected intestine and intussusception head were observed with 5~10 MHz ultrasound, and the abdominal cavity was scanned intermittently for a sudden increase in fluid and simultaneous leakage from the colon. If the intussusception is not reduced after the third attempt, it should be stopped immediately. Signs of successful treatment of USGSE: disappearance of the intussusception, visible ileocecal valve, and fluid entering the small intestine without increased peritoneal effusion. All the above procedures were completed by experienced pediatric surgeons and ultrasound specialists.
Air enema group: JS-628 computer remote control enema rectifier from Guangzhou Jinjian Medical Instrument Co., LTD. Atropine 0.01mg /kg was intrascually injected, and waited for 30 min. The child was placed in supine position, paraffin oil was smeated on the Foley urinary duct, and inserted into the urinary duct 6-10cm through the anus. The balloon was filled with air (about 30ml) and fixed. Experienced radiologists operate the "manually controlled pressure colon air injection machine", controlling the pressure between 80 and 120 mmHg (1 mmHg=0.133 kPa), and observe the insertion and reduction under X-ray fluoroscopy. Change the pressure of the enema according to the tightness and position of the child's cuff, with each time≤3 minutes and a maximum of 3 repetitions. The successful sign of enema is the " burst inflation" of the small intestine.
Children who were successfully treated with enema reduction were kept in the ward for observation for at least 24 hours, and ultrasound was repeated every 24 hours to assess complications and recurrence. The recurrent children were re-evaluated and treated with enema or exploratory laparotomy.
1.3 Outcome measures included demographic data (sex, age, weight, etc.), symptoms (vomiting, abdominal pain/paroxysms, bleeding in the stool, diarrhea, abdominal distention, constipation, abdominal mass, and history), body temperature, laboratory tests (white blood cell count, neutrophil percentage), proportion of unsuccessful reduction resulting in exploration laparotomy, and proportion of intestinal perforation complications.
1.4 Statistical processing SPSS22.0 software was used, and counting data were expressed as cases or percentages, using χ2Test, calibration test or Fisher's exact test; Measurement data to x̄± S, using the t-test of independent samples. P < 0.05 indicated statistically significant difference.