小儿急性肠梗阻诊治分析

目的：分析急性肠梗阻的发病原因、诊断及治疗方法。方法回顾分析安徽省儿童医院普外科2012年1月至2014年12月收治的496例急性肠梗阻患儿资料,按发病原因进行分类,并比较保守及手术治疗患儿的比例。结果496例急性肠梗阻患儿中,疑有器质性病变继发急性肠套叠203例(40．9%),嵌顿性腹股沟斜疝147例(29．6%),粘连性肠梗阻36例(7．2%),急性假性结肠梗阻25例(5．0%),先天性巨结肠24例(4．8%), Meckel 憩室及肠重复畸形18例(3．6%),肠扭转、肠旋转不良13例(2．6%),阑尾脓肿9例(1．8%),内疝(系膜裂孔疝)6例(1．2%),炎性、粪石、柿石性5例(1．0%),其他少见病因10例(2．0%)。203例疑有器质性病变继发急性肠套叠的患儿中,148例(72．9%)施行了手术治疗,55例(27．1%)予空气灌肠复位成功。嵌顿性腹股沟斜疝均予手术。导致粘连性肠梗阻的前次手术中,阑尾切除术14例(38．9%),肠套叠整复术8例(22．2%)。结论急性肠套叠、嵌顿性腹股沟斜疝、粘连性肠梗阻是小儿急性肠梗阻发病的主要原因。大多数疑有器质性病变继发急性肠套叠及全部嵌顿性腹股沟斜疝需手术治疗,腹腔镜手术是小儿急性肠套叠及嵌顿性腹股沟斜疝较好的手术方式。

Diagnosis and treatment of acute intestinal obstruction in children

Objective To analyze the clinical spectrum, diagnosis and treatment of acute intestinal obstruction in children in Anhui Province Children′s Hospital. Methods The clinical data of 496 cases of acute intestinal obstruction in children admitted from January 1, 2012 to December 31, 2014 in the department of Pediatric Surgery in the hospital were analyzed retrospectively. Results There were 496 cases diagnosed with acute intestinal obstruction in children including 203 cases ( 40. 9%) of acute intussusception, incarcerated inguinal hernia (147 cases, 29. 6%) adhesive intestinal obstruction (36 cases, 7. 2%), acute colonic pseudo-obstruction (25 cases, 5. 0%), Hir-schsprung (24 cases, 4. 8%), Meckel diverticulum and intestinal duplication (18 cases, 3. 6%),volvulus, malrotation,appendiceal abscess (13 cases, 2. 6%),internal hernia(mesenteric hernia)(6 cases, 1. 2%), intestinal obstruction by gallstone, meconium and persimmon be-zoar (5 cases,1. 0%), and other rare causes (10 cases,2. 0%). Among 203 cases of acute intussusception suspected secondary to organic disease, 148 cases(72. 9%) were required surgical intervention eventually, and the remaining 55 cases (27. 1%) received air enema and recovered. Incarcerated inguinal hernia received surgical intervention. The previous surgery leading to adhesive intestinal obstruction was lis-ted as follows:14 cases (38. 9%) of appendectomy and 8 cases (22. 2%) of intussusception diorthosis. Conclusion Acute intussuscep-tion, incarcerated inguinal hernia and adhesive intestinal obstruction are the leading causes of acute intestinal obstruction in the cases. Most of acute intussusception and all incarcerated inguinal hernia need operation. Laparoscopic operation is good for acute intussusception and in-carcerated inguinal hernia.