空气灌肠诊治小儿肠套叠的临床应用

目的 探讨透视下空气灌肠诊断小儿肠套叠及气压灌肠复位的临床应用价值.方法 对病程＜48h的150例急性肠套叠空气灌肠的诊断、治疗进行回顾性分析.结果 空气灌肠对肠套叠诊断率100％,合理应用气压灌肠使138例成功复位,成功率约92％.结论 空气灌肠为诊治小儿肠套叠起到了重要的作用,具有疗程短、创伤小、成功率高等方面的优势.     

小儿肠套叠空气灌肠诊疗体会

目的：小儿肠套叠空气灌肠诊疗的体会和应用价值。方法：2000年1月-2005年12月本院对126例临床诊断肠套叠的患儿进行空气灌肠诊断与整复，整复未成功者行外科手术。结果：空气灌肠整复成功112例，整复成功率88．9％，其中14例复位失败后改行手术治疗。结论：小儿急性肠套叠只要符合适应症并无其他并发症；空气灌肠为小儿急性肠套叠首选且经济的治疗方法。     

针灸配合空气灌肠整复小儿肠套叠的研究

目的:探讨针灸配合空气灌肠在整复小儿肠套叠中的价值。方法:取足三里、合谷、天枢、中脘、关元等穴位,毫针直刺,深度0.5-1寸,用泻法,配合空气灌肠治疗小儿肠套叠。结果:32例肠套叠针灸配合空气灌肠复位成功31例,占96.8％。结论:针灸结合空气灌肠提高了肠套叠的整复率,是小儿肠套叠诊断、治疗的首选方法。     

小儿肠套叠的水灌肠治疗

肠套叠是小儿的一种多发病,肠套叠的非手术治疗包括:空气灌肠复位和钡剂灌肠复位。80年代后期,中国医科大学首次采用0.9％生理盐水灌肠方法治疗小儿肠套叠,疗效肯定,并发症少。笔者收集1993年12月～1996年3月的小儿肠套叠水灌肠治疗108例,现报告如下。     

小儿急性肠套叠68例临床分析

目的：为了提高对小儿急性肠套叠的诊治水平。方法：对68例小儿肠套叠进行回顾性分析。其中，男性患儿46例，女性患儿22例。结果：经非手术治疗（空气灌肠复位）48例，手术治疗20例，其中有3例患儿空气灌肠复位失败后手术。全部病例均治愈。结论：（1）肠套叠临床表现不典型者，易误诊。诊断除临床表现外，首选诊断性空气灌肠。（2）根据患儿的病程长短及一般情况而选择不同的治疗方法。     

臭氧混合气体灌肠治疗小儿肠套叠的应用探讨

目的:探讨臭氧与空气混合气体灌肠治疗小儿肠套叠的临床应用价值。方法:搜集本院采用臭氧与空气混合气体灌肠治疗小儿肠套叠的46例患儿(臭氧组)的病例资料,与采用传统空气灌肠治疗的102例患儿(空气组)进行对照分析。结果:臭氧组45例1次复位成功,1例2次复位成功,复位成功率为100%(46/46),一次复位成功率为97.8%(45/46);空气组83例1次复位成功,9例2次复位成功,10例复位失败,复位成功率为90.1%(92/102),一次复位成功率为81.4%(83/102)。两组比较复位成功率,差异有统计学意义(χ2=4.82,P<0.05),一次复位成功率差异亦有统计学意义(χ2=7.34,P<0.01)。臭氧组辐射剂量平均值为(3.56±1.36)mSv,空气组辐射剂量平均值为(5.82±2.25)mSv,两组比较差异有统计学意义(P<0.05)。结论:采用臭氧与空气混合气体灌肠治疗小儿肠套叠,整复率高,患儿辐射剂量小,明显优于传统空气灌肠方法。     

自制空气灌肠器治疗小儿肠套叠46例疗效分析

目的：探讨自制手控空气灌肠器治疗小儿肠套叠的方法、疗效、注意事项及临床应用价值。方法回顾性分析2011年1月至2013年4月收治的46例小儿肠套叠病例资料。结果 X线透视下行空气灌肠治疗46例,成功43例,失败转手术3例,无死亡病例。结论空气灌肠是治疗小儿肠套叠的一种较好方法,具有复位成功率高、创伤小、复位快、费用低等优点。     

空气灌肠整复小儿肠套叠

肠套叠是一种常见小儿急腹症。其诊断方法有：空气灌肠，钡灌肠、腹部B超检查。空气灌肠既可起到诊断作用同时又可进行复位治疗。现结合我院自2003年1月至2004年12月诊治的587例小儿肠套叠作一分析。     

空气灌肠复位术治疗小儿肠套叠312例临床分析

目的：探讨小儿急性肠套叠空气灌肠复位的疗效及并发症.方法：回顾性分析312例肠套叠患儿经空气灌肠诊疗的临床资料.结果：312例患儿,一次性空气灌肠复位成功281例（98%）,复位成功25例2次（8%）,失败6例（2%）.结论：空气灌肠是诊治小儿肠套叠最有效的方法之一,安全性好,并发症少.     

生理盐水灌肠治疗小儿肠套叠

肠套叠是小儿的一种多发病,非手术治疗包括：空气灌肠复位和钡剂灌肠复位。８０年代后期,中国医科大学首次采用０．９％生理盐水灌肠方法治疗小儿肠套叠,疗效肯定,并发症少。作者１９９３年１２月～１９９６年３月共收集肠套叠水灌肠患儿１０８例,现报告如下。１　临床资料和方法１．１　临床资料：本组共随机收集肠套叠水灌肠复位患儿１０８例,其中男７２例,女３６例,年龄１个月～４岁,平均年龄７．５月。治疗前诊断明确,病史１～４８ｈ,随访３２例,时间为１～１５ｄ。１．２　治疗方法：均采用Ｂ超引导下０．９％生理盐水灌肠…     

针灸配合气或钡灌肠整复小儿肠套叠的研究

目的:提出针灸配合透视下灌肠治疗小儿肠套叠的方法,探讨针灸配合气或钡灌肠在整复小儿肠套叠 中的价值。方法:取足三里、合谷、天枢、关元、中脘等穴位,毫针直刺,深度0.5～1寸,用泻法,针后配合气或钡灌 肠治疗小儿肠套叠;并与传统气、钡灌肠整复肠套叠的成功率作对比。结果:试验组气或钡灌肠各32例,成功率分 别是31/32(96.9%)、30/32(93.7%),对照组气或钡灌肠各30例,成功率分别是26/30(86.6%)、25/30(83.3%)。 结论:气或钡灌肠结合针灸对整复小儿肠套叠较单纯灌肠整复率高,可作为小儿肠套叠治疗的首选方法。     

脉冲式空气灌肠治疗小儿肠套叠(附86例分析)

目的:探讨脉冲式空气灌肠治疗小儿急性肠套叠的临床价值和疗效。方法:经肛门插入Foley气囊导管,连接脉冲灌肠整复仪,先行诊断性空气灌肠,确诊为肠套叠后行脉冲空气整复,难复型结合手法按摩,本组病例气压选择在8~16KPa之间。结果:86例患者中,回—结肠型72例(83.7%),回—回—结肠型14例(16.3%),套头位于回盲部25例,升结肠17例,结肠肝曲14例,横结肠8例,结肠脾曲9例,降结肠5例。81例患者复位成功,成功率约94.2%。结论:脉冲式空气灌肠能减轻套叠部位的痉挛与水肿,提高肠套叠的整复成功率。     

提高小儿肠套叠空气灌肠整复成功率及预防并发症的探讨

目的:提高小儿急性肠套叠空气灌肠整复成功率及预防并发症。方法:对268例临床诊断为急性肠套叠患儿进行空气灌肠整复。结果:空气灌肠整复成功252例(94%),其中24例经2次整复成功,2例在术前麻醉后第三次整复成功,失败16例。结论:空气灌肠是诊断与治疗小儿肠套叠的最好方法,不仅能有效地提高整复成功率,还能避免并发症的发生。     

Air enema for diagnosis and reduction of intussusception: clinical experience and pressure correlates

Air enema was used for exclusion, diagnosis, initial movement, and complete reduction of intussusception in 186 pediatric patients. Average pressure needed for initial movement of intussusception was 56.5 mm Hg; average maximum pressure of 97.8 mm Hg was required for complete reduction. Average fluoroscopy time required for intussusception reduction was 94.8 seconds; an average of 41.8 seconds was required to exclude intussusception. Intussusception was diagnosed in 75 patients, and reduction was accomplished in 65 (87%). Of 100 consecutive patients that underwent hydrostatic reduction of intussusception at the authors' institution, reduction was successful in 55. Compared with hydrostatic enema, air enema involves shorter fluoroscopy time and lower radiation dose to the patient. Air enema is safe and effective for diagnosis and treatment of intussusception in infants and children and has replaced hydrostatic enema for such procedures at the authors' institution.     

Therapeutic enema for pediatric ileocolic intussusception: using a balloon catheter improves efficacy

A therapeutic enema for pediatric intussusception may benefit by using a rectal catheter with an inflated balloon. We compared the efficacy of rectal catheters without and with an inflated balloon for air and liquid enemas. We retrospectively reviewed PACS images and hospital records of children who had a therapeutic enema for intussusception at our institution between January 2006 and May 2011. Sixty-two enemas in 60 children were included. Physician assistants with training in pediatric fluoroscopy and pediatric radiologists were more likely to use air enema (37/41 or 90 %), and general radiologists were more likely to use liquid enema (18/21 or 86 %). However, the reduction rate for air enema overall was only slightly higher than for liquid enema using an inflated balloon catheter (36/40 or 90 % versus 14/17 or 82 %) (P?=?0.653). For air enema, mean procedure time for successful reductions was shorter with an inflated balloon catheter than with a plastic catheter (7.6 versus 28.2 min) (P?<?0.009), but the reduction rate was not affected. For liquid enema, the reduction rate was higher with an inflated balloon catheter than without inflation (14/17 or 82 % versus 1/5 or 20 %; P?=?0.021), but the procedure time was not shortened. No procedural complications were directly attributed to using a rectal catheter with an inflated balloon. Using a rectal catheter with an inflated balloon appears to safely shorten the procedure time of a successful air enema and improve the reduction rate of liquid enema.     

Intussusception: the use of delayed, repeated reduction attempts and the management of intussusceptions due to pathologic lead points in pediatric patients

OBJECTIVE: The nonoperative management of intussusception continues to evolve and is the subject of ongoing debate. Our purpose was to assess our current enema reduction rate and to focus on two specific issues that have received little attention in the literature: first, the value and safety of using delayed, repeated reduction attempts and, second, the management of intussusceptions due to lead points. MATERIALS AND METHODS: We performed a retrospective analysis of all intussusception cases seen at the Hospital for Sick Children, Toronto, Canada, a tertiary pediatric hospital, from May 1999 to December 2002. RESULTS: There were 163 children with a total of 219 intussusceptions. Enema reduction was attempted in 211 (96%). Reduction rate with air enema was 90.2%. Delayed reduction attempts were used in 25 patients (15.3%) in 26 intussusceptions (12.3%) and were successful in 50% of the cases. Lead points were documented in 13 children (8%); sonography depicted the lead points in seven (53.8%) of the 13. The reduction rate of intussusceptions due to lead points was 63.6% (14/22). CONCLUSION: Air enema associated with the use of delayed, repeated reduction attempts is a safe and effective approach for intussusception reduction with a high success rate. Delayed, repeated reduction attempts should be considered when the initial attempt manages to move the intussusceptum and the patient remains clinically stable. The management of intussusceptions due to lead points remains a challenge. Sonography does not depict all lead points, and the indication for other imaging studies should be tailored according to each particular patient. We recommend attempted enema reduction in all patients with lead points.     

Comparison of oxygen and barium reduction of ileocolic intussusception

Reports that gas reduction of ileocolic intussusception has a better success rate than traditional barium reduction prompted us to evaluate this technique and to compare the results with our previous experience with barium. Our method of intussusception reduction uses oxygen at a flow rate of 2 l/min and with a maximum pressure of 80 mm Hg. The results of 65 consecutive patients with 69 episodes of intussusception over a 9-month period were retrospectively reviewed. For eight episodes, gas enema was not used, including six patients who had barium reduction during the introduction of the gas technique and two patients in whom no intussusception was seen during gas enema were excluded. In the remaining 61 episodes, six patients were considered to be unacceptable risks for attempted therapeutic reduction with either oxygen or barium, according to our current criteria, and had primary surgery. Enemas with oxygen were attempted in 55 cases and were successful in 40 (73%). If all 61 cases with confirmed intussusception are included, the overall success rate with oxygen was 66%. We had greater success with oxygen than with barium (73% vs 53%), although identical pressures were used and the number of severely ill patients referred for therapeutic enema (90% vs 60%) had increased. The change in the referral pattern reflects the adoption of less conservative criteria for excluding patients from having therapeutic enema. No complications have occurred to date. We have had greater success with the use of oxygen than with that of barium, and have had no complications. Therefore, at our institution, oxygen has superseded barium for the therapeutic reduction of ileocolic intussusception.     

Intussusception in infancy and childhood

Experiences of the diagnosis and treatment of 41 patients with intussusception are presented. The most common signs and symptoms upon presentation were vomiting (83%), colicky pain (83%), rectal bleeding (66%) and abdominal mass (51%). All four features occurred together in only 20% of cases. Ultrasound was the primary mode of investigation in four children, giving a finding characteristic of intussusception. 27 patients were examined with barium enema, and hydrostatic reduction was tried. A barium enema gave the correct diagnosis on all cases and a successful reduction of sign and symptoms in 12 patients (44%). In the other 29 cases laparotomy was performed to achieve reduction, primarily in 14 patients and after an unsuccessful barium edema in 15.84% of the patients presenting after a delay of more than 24 hours needed surgery, compared with 59% of those presenting earlier.     

Childhood intussusception: US-guided hydrostatic reduction.

Over a 30-month period, real-time ultrasound (US) was performed in 116 children with suspected intussusception. US findings were positive in all 75 cases of intussusception. Except in one case of transient small-bowel intussusception, the authors immediately attempted US-guided hydrostatic reduction in all cases. Reduction was successful in 63 cases (85%), as demonstrated with US and resolution of signs and symptoms of intussusception. Negative sonograms were confirmed with clinical follow-up. Among 11 failed cases, reduction with barium enema was attempted in six, but all attempts failed. No complications have occurred to date. The authors conclude that US is a reliable diagnostic screening modality in cases of suspected intussusception and that US-guided hydrostatic reduction is a promising technique in nonoperative treatment.     

超声监视下温生理盐水加压灌肠治疗小儿肠套迭

目的探讨超声监视下温生理盐水加压灌肠治疗小儿肠套迭的方法，以寻求小儿肠套迭非手术治疗的最佳方式。方法69例肠套迭患儿均行超声监视下温生理盐水加压灌肠复位。结果超声诊断准确率达100％(69／69)；复位成功65例，失败4例，后者行手术治疗。无一例发生肠穿孔。结论超声引导下温生理盐水加压灌肠治疗小儿肠套迭，操作简便、安全、对患儿无损伤，值得在临床推广。