目的:我们进行了一项全面的荟萃分析,以比较透视引导下空气灌肠复位(FGAR)和超声引导下水压灌肠复位(UGHR)治疗小儿肠套叠的有效性和安全性。
方法:对从各种数据库获得的回顾性研究进行了系统综述和荟萃分析,包括公共的,MEDLINE,科克伦,谷歌学者,中国国家知识基础设施(CNKI),万方,VIP数据库搜索包括2003年1月1日至2023年3月31日的出版物,最后一次搜索是在2023年1月15日完成的。
结果:我们纳入了49项随机对照研究和回顾性队列研究,共涉及9,391例患者,UGHR有4,841个,FGAR有4,550个。具体来说,UGHR表现出明显更短的还原时间(WMD=-4.183,95%CI=(-5.402,-2.964),P<0.001),成功率较高(RR=1.128,95%CI=(1.099,1.157),P<0.001),住院时间缩短(WMD=-1.215,95%CI=(-1.58,-0.85),P<0.001)。此外,UGHR重新定位与总体并发症发生率降低相关(RR=0.296,95%CI=(0.225,0.389),P<0.001)和穿孔发生率降低(RR=0.405,95%CI=(0.244,0.670),P<0.001)。
结论:UGHR具有非放射性的优点,实现更短的还原时间,特别是在重新定位方面表现出更高的成功率,导致术后住院时间缩短,术后并发症的总体发生率较低,包括降低相关穿孔的风险。
OBJECTIVE: We conducted a comprehensive meta-analysis to compare the effectiveness and safety of fluoroscopy-guided air
enema reduction (FGAR) and ultrasound-guided hydrostatic
enema reduction (UGHR) for the treatment of intussusception in pediatric patients.
METHODS: A systematic
review and meta-analysis were conducted on retrospective studies obtained from various databases, including PUBMED, MEDLINE, Cochrane, Google Scholar, China National Knowledge Infrastructure (CNKI), WanFang, and VIP Database. The search included publications from January 1, 2003, to March 31, 2023, with the last search done on Jan 15, 2023.
RESULTS: We included 49 randomized controlled studies and retrospective cohort studies involving a total of 9,391 patients, with 4,841 in the UGHR and 4,550 in the FGAR. Specifically, UGHR exhibited a significantly shorter time to reduction (WMD = -4.183, 95% CI = (-5.402, -2.964), P < 0.001), a higher rate of successful reduction (RR = 1.128, 95% CI = (1.099, 1.157), P < 0.001), and a reduced length of hospital stay (WMD = -1.215, 95% CI = (-1.58, -0.85), P < 0.001). Furthermore, UGHR repositioning was associated with a diminished overall complication rate (RR = 0.296, 95% CI = (0.225, 0.389), P < 0.001) and a lowered incidence of perforation (RR = 0.405, 95% CI = (0.244, 0.670), P < 0.001).
CONCLUSIONS: UGHR offers the benefits of being non-radioactive, achieving a shorter reduction time, demonstrating a higher success rate in repositioning in particular, resulting in a reduced length of postoperative hospital stay, and yielding a lower overall incidence of postoperative complications, including a reduced risk of associated perforations.