B超引导下改良水压灌肠治疗小儿肠套叠

分析Ｂ超引导下改良水压灌肠治疗小儿肠套叠的疗效，介绍使用方法和意义。本组为１６８例小儿肠套叠，男１３０例，女３８例，全部采用Ｂ超引导下改良水压灌肠法治疗。灌肠特点是以自制密闭式手控加压灌肠器连接直径为０．６～０．８ｃｍ的肛管进行。１６８例患儿中，１５４例（９１．７％）为回结型肠套叠，１０３例病程不满４８小时。小儿的年龄为２．５月～４岁。１６１例复位成功，治愈率９５．８％（１６１／１６８）。７例非回结型套叠复位失败。我们认为，本灌肠技术简易、安全可靠。使用这种技术，监测压力方便，疗效满意。     

超声监视下水压灌肠治疗小儿急性肠套叠10年总结

目的探讨在超声监测下水压灌肠复位治疗小儿肠套叠的临床应用价值。方法收集本院2003年9月至2014年1月利用超声监测下水压灌肠复位治疗的1202例小儿肠套叠病例资料,并和 X 线空气灌肠复位进行对照分析。结果1202例中,1150例复位成功,复位成功率达95．67％,无一例出现并发症;复位成功后口服活性炭0．3-0．5 g,经6-8 h 肛门排出黑色炭未。结论超声监测下水压灌肠复位治疗小儿肠套叠具有复位成功率高、安全性大等优点,值得临床推广应用。     

超声下水压灌肠治疗肠套叠技术改进及评价

目的 通过对治疗肠套叠疾病气压和水压灌肠治疗结果统计分析,探讨气压灌肠和水压灌肠产生的压力对肠道及机体的影响;探讨两种方法的优劣;探讨治疗的安全性;探讨肠套叠的最佳治疗方案.方法 1996～2015年,20年间我院治疗肠套叠患儿1 249例,其中男818例,女431例.根据治疗方法不同,设三个时段分为三种方法:1996～2000年为X线气压灌肠阶段(方法①)173例;2001～2005年X线下气压灌肠向水压灌肠过渡阶段(方法②)220例,2006～2015年B超下水压灌肠阶段(方法③)856例.统计非手术治疗肠套叠整复率、失败率.结果 方法①、②、③总有效率分别为85.0％、86.8％、95.0％,总平均有效率88.9％;复位失败率分别为15.0％、13.2％、5.0％,平均失败率11.1％,方法②与①差异无统计学意义(P＞0.5),方法③与①、②相比,差异有统计学意义(P＜0.005).气压灌肠产生压力快不容易掌控,肠套叠整复率相对较低,易造成肠腔胀气及损伤,安全性差,而且在X线下操作对人体存在潜在性损伤;水压灌肠产生压力较缓慢,作用温和,可反复作用于套叠部位,整复率高,对肠道无明显影响,安全性有保障,而且在B型超声下监视操作对人体无明显影响.结论 B型超声监视下水压灌肠是目前治疗肠套叠疾病最佳的方法,具有操作简便、易懂、易学、易掌握的优点,避免了X线对人体伤害,整复率高,减少手术发生率,安全性高,是临床值得推广的项目,特别值得基层医院推广使用.     

彩超监视下水压灌肠治疗小儿肠套叠36例

肠套叠是常见的小儿急腹症。2005年1月～2006年6月我院采用水压灌肠复位治疗小儿肠套叠36例,疗效满意。现总结如下。     

彩超引导下水压灌肠治疗小儿肠套叠疗效分析

目的探讨彩超引导下水压灌肠治疗小儿肠套叠的影响因素及注意事项,以提高整复成功率。方法2008年6月至2009年9月,本院经超声检查诊断为小儿肠套叠181例,其中2例病情危重直接行开腹整复手术,179例行彩超引导下水压灌肠治疗,根据水压灌肠是否成功,将179例患儿分为成功组和失败组,对两组患儿性别、年龄、病程、有无血便、水压灌肠时间、灌肠温盐水量、灌肠压力（灌肠器距诊疗床高度）进行Х^2检验;对差异有统计学意义的因素进行Logistic回归分析,确定影响水压灌肠成功的相关因素。结果两组在性别、年龄、有无血便以及灌肠压力上比较,差异无统计学意义（Х^2=0．385,P=0．535;Х^2=0．112,P=0．738;Х^2=1．139,P=0．286;Х^2=0．821,P=0．365）,在病程、水压灌肠时间、灌肠温盐水量等方面比较,差异有统计学意义（Х^2=13．820,P〈0．001;Х^2=13．894,P〈0．001;Х^2=4．871,P〈0．05）。Logistic回归分析发病时间、水压灌肠时间、灌肠温盐水量的OR值分别为0．138、0．992、0．996。结论病程、水压灌肠时间、灌肠温盐水量是影响彩超引导下水压灌肠治疗小儿肠套叠成功的主要因素,对病情危重者应直接行开腹手术。     

静脉麻醉在肠套叠小儿水压灌肠复位中的临床应用

我院2004年共收治肠套叠小儿62例，在B超监视下经静脉麻醉完成水压灌肠复位，取得良好临床效果，现报告如下。     

空气灌肠治疗小儿急性肠套叠

目的总结空气灌肠整复小儿肠套叠的经验。方法回顾性分析44例小儿肠套叠病例，从诊断、治疗、术前准备、术后护理、诊断治疗标准等方面进行分析总结。结果44例全部一次性成功整复，没有发生穿孔、粘连等并发症。结论空气灌肠整复小儿肠套叠安全有效，简单方便。是外科手术前必须施行的首选保守治疗方法。     

B超引导下水压灌肠复位治疗小儿急性肠套叠280例

B超诊断小儿急性肠套叠影像直观,准确率可达100%。国内外对于小儿急性肠套叠的处理,普遍采用X线或B超监视下空气或钡灌肠复位治疗。我们认为,诊断明确后可根据病情,选择性地在超声监视下行水压灌肠复位治疗。本院近年来采用超声诊断小儿急性肠套叠290例,其中280例采取B超引导下水压灌肠复位治疗,均取得满意疗效,现报告如下。     

改良灌肠液水压灌肠复位肠套叠效果观察

目的研究B超监视下水压灌肠复位肠套叠中用改进的灌肠液对复位后效果的影响。 方法中国医科大学附属二院小儿外科于2003年2~8月,将收治的63例肠套叠患儿以随机数表随机分为对照组30例及观察组33例,均应用B超监视下水压灌肠成功复位,对照组应用普通灌肠液,观察组应用改进的灌肠液,对观察组中存在血便患儿复位后应用改进的灌肠液加云南白药保留灌肠。比较观察组与对照组灌肠液大便菌落计数及复位后并发症的发生情况,进行统计学分析。 结果观察组与对照组复位后灌肠粪液的菌落计数比较,观察组明显减少(P<0.05);观察组与对照组灌肠复位后,并发症及血便次数比较,观察组均明显减少(P<0.05)。 结论肠套叠灌肠液的改进可以使灌肠液成为水压灌肠复位治疗肠套叠的重要辅助手段,可显著减少肠套叠复位后并发症的发生。     

B超引导下水压灌肠诊治小儿肠套叠学习班在黄山举办

安徽省立医院小儿外科举办的国家级医学继续教育学习班“B超引导下水压灌肠诊治小儿肠套叠”于2008年4月24日至28日在黄山市成功举办。讲座由中华小儿外科学会常委、安徽省儿外科分会副主任委员王忠荣教授主持，安徽省医学会王尚柏秘书长致开幕词。     

Hydrostatic reduction of intussusception: barium, air, or saline?

While there is agreement that hydrostatic reduction (HR) is the ideal first-line treatment for childhood intussusception, there is controversy about which technique is best, namely, barium, air, or saline. We present our experience in the Pediatric Surgical Center, University of Alexandria, in HR of intussusception under ultrasound (US) guidance. The study was divided into two phases: between 1983 and 1990 and between 1991 and 1998. HR was started gradually in phase I, and became routine in phase II. Diagnosis and reduction were done by the pediatric surgical staff. The success rate was 71.7% in phase I and 85.5% in phase II. Most unreduced cases were the ileo-ileocolic type: 58.6% in phase I and 69.3% in phase II. HR under US guidance is equal or superior to other techniques of reduction, while having the obvious advantage of avoiding radiation exposure. Accepted: 8 November 1999     

Ultrasound guided hydrostatic reduction in the management of intussusception

Objective: A case series study was conducted for two years from 01 June 2002 to 01 June 2004 to study the efficiency of ultrasound guided hydrostatic reduction in the management of intussusception in children.Methods: A total of 25 patients who underwent the procedure were evaluated. All the patients were diagnosed by High Resolution Ultrasonography (HRUSG). Continuous monitoring of the progress of reduction during the procedure was done by HRUSG. 500–1000 ml (average 600 ml) of normal saline was used.Results: 24 out of 25 (96%) intussusceptions were successfully reduced. Average time taken was 15 minutes. All the patients were reviewed after 24 hrs for recurrence. None of them showed recurrence within 24 hrs. No complications were observed.Conclusion: The study concludes that ultrasound guided hydrostatic reduction is a safe, simple and effective method for treatment of intussusception in children.     

Reduction of intussusception in infants by a pediatric surgical team: improvement in safety and outcome

Commonly, reduction of intussusception is performed by experienced radiologists. We review the performance of a pediatric surgical team for treating intussusception according to a standard protocol and present our findings. Three hundred and seventy eight patients with signs and symptoms of intussusception we treated from 1980 to 2005 were reviewed. Hydrostatic reduction (HR) was performed using a water-soluble contrast agent under fluoroscopy unless there was a serious condition clinically. Before 1998, HR was performed exclusively by pediatric surgical trainees (period A). In 1998, a standard protocol (double-balloon tube, maximum pressure of 120 cmH₂O, repeated a maximum of five times, and HR performed by a pediatric surgical trainee under the supervision of a consultant pediatric surgeon) was adopted (period B). As part of the protocol, the operating room was notified of the HR procedure and placed on call for emergency surgery. Of the 378 patients, 21 required immediate laparotomy due to serious general condition, leaving 138 during period A and 219 during period B who had HR. Patient age, sex, and duration of symptoms (period A, 14.5 ± 7.8 h; period B, 13.1 ± 9.9 h) were not statistically significant. Success of HR during period A was 64.5%, and significantly improved for period B at 94.5% (P < 0.01). During period B, 128 of our patients had been referred from elsewhere for failed reduction attempted by radiologists or pediatricians. We were able to perform HR successfully in 118 of these (92.2%). During period A, it was significantly less at 54.0% (P < 0.01). Bowel perforation during HR occurred in two patients during period A (1.4%) and two patients during period B (0.9%), but the latter cases were transferred immediately for emergency surgery with good outcome. Reduction of intussusception by a pediatric surgical team would appear to be significantly safer with better outcome, and is thus more efficient.     

Childhood intussusception: Hydrostatic reducibility and incidence of leading points in different age groups

A series consisting of 658 radiologically diagnosed intussusceptions is analysed. Hydrostatic reduction was successful in 85.2% of cases, the incidence of failure amounting to 14.8%. Analysis demonstrated a marked difference in reduction rate in different age groups. The lowest rate of success was recorded in children over 5 years of age, the group with the highest incidence of leading points. The next lowest rate of success was in those below age 1 year where the frequency of failure was more than 50% higher than in the ages between 1 and 5 years. However, the rate of leading points was approximately the same in both the latter groups and close to the average in entire series. There is no reason to refrain from barium enema reduction in any age group although special care should be exercised in the neonate. With a reasonable experience of method, the risk of overlooking a surgically significant lesion is negligible.     

高频彩超及全控式水压复位器诊治幼儿肠套叠

目的总结彩超下水灌肠诊治急性肠套叠的经验。方法采用高频超声定位并诊断肠套叠,用彩色多谱勒显像（CDFI）确定套叠部血流动力学改变,判断是否适宜灌肠复位,并用自制全控式水压复位器于高频彩超监测下灌肠复位。同期设立临床诊断70例肠套叠患儿为对照组,经低频（3．5MHz）B超诊断、监测并分次注水灌肠复位。结果72例拟诊幼儿肠套叠病例中明确诊断68例,判断不宜灌肠3例（经手术证实为难复性肠套叠,肠缺血严重。65例以全控式水压复位器于高频彩超监测下灌肠复位全部成功。对照组70例临床诊断幼儿肠套叠病例在低频B超监测下分次注水灌肠复位治疗56例,44例成功。结论全控式水压复位器结合高频彩超治疗幼儿肠套叠较之低频B超分次注水复位法,指征更明确,治疗更安全快速,效果更好,便于基层医院推广。     

The efficiency and limitations of barium enema in the treatment of intussusception in infancy and childhood

Sixty-one children with intussusception were treated during a period of 7 years. A barium enema was routinely performed for diagnosis and treatment unless signs of gangrenous bowel were present. Hydrostatic reduction was successful in 50% of attempts in the idiopathic cases. There were no complications from this procedure and no recurrence of intussusception. At surgery the intussusception was found to be reduced in 6 of 32 patients; 19 underwent operative reduction; and resection was performed in 7. A higher failure rate of hydrostatic reduction was associated with older patient age, longer duration of symptoms, and the presence of a pathological leading point.     

Intussusception in the 1990s: has 25 years made a difference?

To evaluate the current management of the infant and child with intussusception, the medical records of 188 consecutive intussusception patients over 5 years (1985–1990) were reviewed and compared to our series from 25 years ago (1959–1968). The peak months changed from May and June to January and July. Duration of symptoms and signs prior to diagnosis increased by one-third to 35 h with, however, a decrease in the incidence of pain, vomiting, abdominal mass, and rectal blood. Air was the only contrast used for the hydrostatic enema in the present series and was tried in every case with 81% success; this is a major improvement from 45% in the old series. There were three perforations (1.4%) with air-enema attempts compared with 1 (0.2%) 25 years ago. Recently only 19% of patients required operation but 30% needed resection; 55% of the patients in the older series required operation and 20% needed resection. Ten percent of intussusceptions continue to be found spontaneously reduced at operation. There were many less pathologic lead points in the newer series. The recurrences increased from 4% to 7%, but their reduction rate also increased from 31% with barium to 100% with air. There were no deaths in the last 25 years.     

2037例小儿急性肠套叠的诊治体会

目的 对小儿急性肠套叠病例的临床特点、诊断和空气灌肠治疗方法进行探讨。方法 分析总结2037例小儿急性肠套叠的临床表现和X线下空气灌肠复位的诊治效果。结果 2037例均以肠套叠四大症状(阵发性哭闹、呕吐、血便和腹部包块)中两个或以上为主要表现,X线监视下低压空气灌肠诊断、空气灌肠治疗和手法推挤按摩整复成功1972例,成功率为96．8％,未复位65例(占3．2％)。穿孔2例(占0．98‰)。结论 早期正确诊断、空气灌肠及手法按摩整复治疗明显提高小儿急性肠套叠整复率;空气灌肠是肠套叠诊疗的首选方法。     

Isolated traumatic gallbladder rupture: US findings and the role of repeat US in diagnosis

We represent the US findings of isolated gallbladder rupture caused by blunt abdominal trauma in a 13-year-old boy. At the initial US examination, although a pericholecystic fluid collection was observed, the mildly collapsed gallbladder was regarded as a contracted gallbladder. Even though the patient was haemodynamically stable, repeat US examination after 24 h revealed gallbladder perforation. In haemodynamically stable trauma patients repeated US examinations can be useful and are strongly recommended.