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Amaç: İntususepsiyon, ameliyatsız tedavi yöntemlerinin önemli bir rol oynadığı bebekler ve küçük çocukları ilgilendiren yaygın bir durumdur. Bu çalışmanın amacı, intususepsiyonlu hastalarda ultrason kılavuzluğunda yapılan salin lavmanla redüksiyon konusundaki 20 yıllık tecrübemizi sunmaktır. Yöntem: Ocak 1999 - Aralık 2018 tarihleri arasında 20 yıllık süreyi kapsayan bu retrospektif çalışma, Ocak 1999’dan Aralık 2018’e kadar Tebriz çocuk hastanesinde İran’da gerçekleştirildi. Çalışmaya dahil edilen adaylar, intususepsiyon teşhisi konan 0 ila 14 yaş arası çocuklardı. Tedavi seçeneği (cerrahi veya salin lavmanı redüksiyon), salin lavman redüksiyon birincil ve toplam başarı oranı, erken rekürrens oranı, ameliyat ayrıntıları ve sürükleyici noktaları ile birlikte kaydedildi. Bulgular: İntususepsiyonu olan toplam 1376 hasta çalışıldı. 112 hasta spontan redüksiyon yaşadı ve 1131 hastaya ultrasonografi kılavuzluğunda salin lavman redüksiyonu uygulandı. Birincil girişim hastaların %76,8’inde (874 vaka) başarılı oldu; ancak, hastaların %8,4’ünde (74 vaka) redüksiyondan 48 saat sonra rekürrens kaydedildi. 264 hasta ikinci ve/veya üçüncü redüksiyon için önerildi. Lavman redüksiyon genel başarı oranı %79,9 idi. Başarılı redüksiyonu olan çocukların yaş ortalaması başarısız gruba göre daha düşüktü (1,27±1,27’ye karşı 1,63±1,05; p=0,001). Çilek jölesi dışkısı ve ele gelen kitle bulguları olan hastalarda başarı oranı anlamlı olarak daha düşüktü (p<0,001). 364 hastaya (%26,5) cerrahi tedavi uygulandı. Sürükleyici nokta 64 hastada fark edildi ve Meckel divertikülü (%63,24) en sık belirlenen patolojiydi. Sonuç: Ultrason eşliğinde salin lavmanla redüksiyon, uygulanabilir bir yöntemdir ve intususepsiyonun ameliyat dışı yönetimi için etkili ve güvenli bir yöntem olarak önerilmektedir. Başarı oranı yüksektir ve tekrarlayan vakalarda bile uygun hasta seçimi ve tekrarlanan redüksiyon girişimleri ile daha da arttırılabilir.
Purpose: Intuuseption is a common condition concerning babies and young children where non-chirurgical treatments play an important role. The aim of this study is to provide us with 20 years of experience in the subject of reduction with saline lavender performed under ultrasound guidance in intuseptic patients. Method: This retrospective study, which covers a 20-year period between January 1999 and December 2018, was carried out in Iran at Tebriz Children's Hospital from January 1999 to December 2018. The candidates included children between the ages of 0 and 14 who were diagnosed with intuseption. The treatment option (chirurgical or saline lavender reduction), saline lavender reduction was recorded with the primary and total success rate, early recurrence rate, surgery details and draw points. A total of 1376 patients with intuseption were studied. 112 patients experienced spontaneous reduction and 1131 patients were applied saline lavman reduction under the ultrasound guidance. The initial initiative was successful in 76.8 percent of patients (874 cases), but in 8.4 percent of patients (74 cases) recurrence was recorded 48 hours after reduction. 264 patients were recommended for second and/or third reduction. Lavman reduction overall success rate was 79.9%. The average age of children with successful reduction was lower than the failure group (1,27±1,27 against 1,63±1,05; p=0,001). The success rate was significantly lower in patients with ointment jelly ejaculation and mass findings addressed (p<0,001). 364 patients (26.5%) were subjected to surgery. The trigger point was observed in 64 patients and the Meckel diverticular (63.24%) was the most commonly identified pathology. The result: Reduction with saline lavender accompanied by ultrasound is an applicable method and is recommended as an effective and safe method for non-operative management of intuseption. The success rate is high and can be increased even in repeated cases with the appropriate patient selection and repeated reduction attempts.
Objective: Intussusception is a common condition involving infants and toddlers in which non-operative management plays an important role. The aim of this study was to present our 20 years of experience of saline enema reduction with ultrasound guide in management of intussusception. Methods: A 20-year retrospective study was performed from January 1999 to December 2018 in Iran, Tabriz Pediatric Hospital. Candidates for inclusion in the study were children from 0 to 14 years old who were diagnosed with intussusception. Treatment option (surgical or saline enema reduction) was recorded along with primary and total success rate of saline enema reduction, early recurrence rate, surgery details and lead points. Results: A total of 1376 patients with intussusception were studied. 112 patients experienced spontaneous reduction, and 1131 patients underwent ultrasonographic guided saline enema reduction. The primary attempt was successful in 76.8% of the patients (874 cases); however, in 8.4% of the patients (74 cases) recurrence was recorded during 48 hours after reduction. 264 patients were referred for second and or third reductions. The overall success rate of enema reduction was 79.9%. The mean age of the children with successful reduction was lower than the failed group (1.27±1.27 versus 1.63±1.05 years old; p=0.001). The success rate was significantly lower in patients with signs of currant jelly stool and palpable mass (p<0.001). 364 patients (26.5%) underwent surgery treatment. Leading points were recognized in 64 patients, and Meckel’s diverticulum (63.24%) was the most common pathologic leading point. Conclusion: Ultrasound-guided saline enema reduction is a feasible method and is suggested as an efficient and safe method for non-operative management of intussusception. Its success rate is high and could be increased further by proper case selection and repeated reduction attempts even in recurrent cases.
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
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