Experience Of 714 Cases And Meta Analysis Of Air Vs Liquid Enema Reduction In Children With Intussusception

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Experience of 714 Cases of air enema reduction in the treatment of intussusception in childrenObjective The aim of this study is to collect and analyse the clinical data of intussusception in children from Department of Pediatric Surgery at Binzhou Medical University Hospital and to explore its diagnosis and treatment experience.Method From January 2016 to December 2018,the clinical data of pediatric intussusception from Department of Pediatric Surgery at Binzhou Medical University Hospital were analyzed retrospect-tively,The contents included as follows:(1)The general condition:age,sex,the course of disease,length of hospital stay.(2)Clinical feature:abdominal pain,paroxysmal crying,vomiting,abdominal mass,bloody stool.Investigation:ultrasound,blood count,stool test,rotavirus test.(3)Treatment:outcome:success/failure,perforation,fever,diarrhea(4)surgical intervention:the choice of surgical methods,the position of point,the type of intussusception,intestinal blood flow,PLP,postoperative complications.The diagnosis of intussusception depends on the clinical diagnostic criteria and severity assess-ment criteria provided by Japanese Guidelines for the Management of Intussusception in children,2011.Children meeting the criteria of "confirmed diagnosis" were included in the study,relevant data and information were collected.SPSS 22.0 statistical software was used for statistical process-ing for all data,?2 test was used for discontinuous count data,and nonparametric test was used for continuous count data.P<0.05 meant that the difference was statistically significant.Results From January 2016 to December 2018,943 cases of intussusception were treated in outpatient clinic,48 cases were excluded from repeated visits,and 895 cases were eventually included.For suspected cases,Suppositories glycerol was given to promote defecation,abdominal need massaged by their parents.Finally,181 cases were excluded and 714 cases were hospitalized There were 466 males and 248 females in 714 children.There were 308 children under the age of 1 year old,242 children aged between 1 and 2 years old,The age ranges from 2 to 3 years have 82 Children,36 children aged ranges from 3 to 4 years and 46 children over the age of 4 years old.714 cases of pediatric intussusception wereadmitted and treated by air emena reduction method.697 cases were successfully reducted,17 cases failuerd to reduction by air enema,No intestinal perfora-tion occurred.70 cases recurred.17 cases underwent surgical treatment due to failure of air enema reduction,including 3 cases of laparoscopic intussusception reduction,3 cases of intraoperative conversion to open surgery and 11 cases of traditional open surgery reduction,all of which were successfully reduction.There are 1 case of Meckel's diverticulum,1 case of intestinal polyps,which confirmed by surgery or histopathologic diagnosis.There is one recurred case postoperatively.70 cases reoccurred for 101 times.The successful rate of reduction by air enema was 99%(100/101)There was no significant difference when compared with intusssception for its first time(x2=0.279,P>0.05).649 cases who had a course less than 24 hours,641 cases successfully redutced by air enema(98.8%)and 8 cases failured to reduction by air enema;38 cases whose disease course lasted for 24-48 hours were successfully reducted by air enema(92.1%)and 3 cases failured to reduct by air reduction;27 cases whose disease course lasted for more than 48 hours,21 cases(77,8%)were successfully reducted and 6 cases failed.The course of the disease had significant impact on the successful rate of air enema reduction(Z=6.523,=<0.05),and the longer the duration,the lower the successful rate of air enema reductionConclusion1.Air enama reduction therapy is one of the preferred choice for the treatment of pediatric intussusception.2.Air enama reduction therapy is effective and there is no significant difference between patients who suffered from intussusception for the first time or recurred3.Surgical intervention is an effective treatment for patients who failed to reduction by non-operative therapy4.With the length of the disease course,the successful rate of reduction by air enema decreased accordingly.It is suggested that early diagnosis and management be issential for pediatric intussusception.Part ? Meta analysis of efficiency and safety of air versus liquid enema reduction in the treatment of children with intussusceptionMethod PubMed,Medline,Cochrane Library,Embase,VIP,CNKI,CBMdisc and Wanfang database were retrieved.The retrieval time was from the establishment of the database to March 1st,2018.Inclusion criteria:Criteria for inclusion were articles that reported the use of either air(air,oxygen,or CO2)or liquid(saline solution,water,barium,or iodinated contrast material)enema in children with a confrmed diagnosis of intussusception and reported either a success rate of enema reduction of intussusception or a perforation rate.Exclusion criteria:Criteria for exclusion were articles that did not mention the type of enema used,did not report enema reduction success rate or perforation rate,were in languages other than Chinese or English,were surveys or reviews,and were not published infull text in peer-reviewed journals.Furthermore,studies with a total of 50 or fewer air or liquid enemas were excluded from analyses to decrease sample size bias and between-study heterogeneity.After the detected literatures being screened,extracted and evaluated,a Meta-analysis was performed using RevMan 5.3 software.Results Finally,a total of 140 articles(76 reporting air enema,64 reporting liquid enema)with 41292 patients were enrolled.In 75 articles(24550 patients),the combined success rate of air enema was 88%(95%CI,86%-89%;I2=95%),and in 64 articles(16092 patients)of liquid enema,it was 80%(95%CI,78%-83%;I2=96%).In 57 articles(20290 patients),the combined perforation rate for air enema was 1%(95%CI,1%-1%;I2=53%),and in 36 articles(10486 patients)of liquid enema,it was1%(95%CI,0%-1%;I2=0%).Among 5430 patients(20 articles)undergoing air enema reduction,the rate of recurrence was 7%(95%CI,5%-9%;I2=85%),and in 10 articles(1792 patients)of liquid enema,it wa11%(95%CI,7%-15%;I2=71%).Conclusion Air enema is superior to liquid enema for intussusception in children.The success rate of air enema is significantly higher than that of liquid enema,and the recurrence rate is significantly lower than that of liquid enema.There is no significant difference in perforation rate.Therefore,we recommend the application of the air enema reduction in the treatment of children intussusception.