ĐÁNH GIÁ KẾT QUẢ ĐIỀU TRỊ LỒNG RUỘT Ở TRẺ EM VỚI PHƯƠNG PHÁP THÁO LỒNG BẰNG HƠI TẠI KHOA NGOẠI NHI – BỆNH VIỆN SẢN NHI TRÀ VINH NĂM 2017

Abstract

Research objective: Survey of clinical and paraclinical characteristics of intussusception in children; Evaluate the results of treatment by pneumatic debulking in children. Method: Prospective study of all children hospitalized in the Department of Pediatric Surgery diagnosed with intussusception and indicated for pneumatic debulking. Results: Gender: male 57%, female 43%. Age group: children < 12 months old accounted for 23.3%, from 12-24 months accounted for 25.5% and children in the age group >24 months accounted for 51.2%. Nutrition: normal weight accounted for 91.9%; overweight was 7% and there was 1 case of malnutrition accounted for 1.2%. History of intussusception: 23.3% of children had recurrent intussusception, not yet: first-time intussusception accounted for 76.7%. Time of admission: early < 48 hours accounted for 89.5%, late > 48 hours: 10.5%. Clinical signs of children when admitted: most children had signs of abdominal pain, crying accounted for 97.7%, vomiting accounted for 66.3%, 17% of children had bloody stools. Physical examination showed: most children had no signs of dehydration accounted for 97.7%, only 2.3% of children had signs of dehydration; 12.8% of children had abdominal distension and when examined, a palpable mass accounted for 95.3%. General condition of children when admitted: lethargic accounted for 26.7%, fever 17%, refusal to breastfeed 31.4%. Most cases of children were still healthy and had no serious symptoms. Ultrasound results showed that 98.8% of children had detected images of the mass through ultrasound, the study cases did not have an indication for abdominal X-ray to support diagnosis. Most cases were admitted to the hospital before 48 hours, accounting for 89.5%, and 10.5% were admitted late after 48 hours. Most cases were successfully removed by air on the first attempt, accounting for 82.5%, 15.1% had to be removed 2 or more times, 1 case could not be removed, the patient's family requested to be transferred to a higher level, 1 case could not be removed and had to be transferred to an emergency surgery. Conclusion: Clinical signs: full clinical signs, especially abdominal pain and crying, accounting for 97.7%. Physical signs: palpable intussusception mass during examination, accounting for 95.3%. General signs: not typical because the patient arrived early, only signs of the child refusing to breastfeed, accounting for 31.4%. Paraclinical: abdominal ultrasound detected intussusception mass, accounting for 98.8%. Results of removing intussusception by air: successful in 1 removal, accounting for 82.5%; removal 2 or more times: 15.1%; Unsuccessful removal: 2.4%. The method of pneumatic debulking under ultrasound for treating intussusception in children is a safe, effective and easy method. Safety: no deaths, no accidents, few complications. Effectiveness: high success rate of 97.6%. Easy to perform: inflating with a pneumatic generator, can be applied in any facility equipped with ultrasound, X-ray and capable of emergency abdominal surgery to handle situations of failed debulking or complications of intestinal rupture.