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。     

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。     

超声诊断和水压灌肠治疗小儿肠套叠

目的：　评价超声诊断和超声监视下水压灌肠治疗小儿急性肠套叠的方法和疗效。方法：　对173例可疑肠套叠患儿进行超声检查,发现有“同心圆”征的同时在超声监视下进行水压灌肠复位治疗。结果：　超声确诊肠套叠32例,诊断准确率100%,其中30例水压灌肠复位成功,复位成功率93.8%。3例回回结型中1例水压灌肠成功,2例失败改手术治疗。结论：　超声诊断小儿肠套叠准确率高,水压灌肠复位成功率高。对回回结型超声可以确诊,但复位成功率低     

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。     

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。     

彩超监视下盐水灌肠整复小儿急性肠套叠的价值

目的评估彩超监视下盐水灌肠整复小儿急性肠套叠的临床价值。方法对经彩超确诊的68例肠套叠患儿,在彩超监视下用温盐水灌肠进行整复治疗。结果68例中,成功63例,复位成功率为92．6％。“虹吸征”、“翻滚征”可作为复位成功的标志之一。联合运用高低频超声、手法护肛、排尽大小便、缓慢升压、手法按摩、拍击背部、变换体位等有利于提高整复成功率。结论小儿急性肠套叠彩超监视下盐水灌肠整复术成功率高、安全、快捷,可作为治疗小儿急性肠套叠的首选方法。     

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。     

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。     

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.     

Intussusception: effectiveness of gas enema

In tertiary paediatric centres, gas enema reduction of intussusception appears to be more effective and perhaps safer than barium enema reduction. Despite the higher success rate of reduction when gas is used, there remain some patients in whom the technique fails but who at operation have an intussusception that theoretically should have been reducible with the gas enema: easy to reduce manually, no necrosis of the bowel, and no pathological lesion at the leadpoint. After a gas enema failed, manual reduction of an intussusception was achieved in 41 of 49 patients and was difficult in less than one-half. It is suggested that a significant proportion might have been reducible had the technique of gas reduction been modified, either by repeating the enema some hours after the first attempt or by using higher insufflation pressures. In practice, clinical features were not useful in predicting in which patients gas enema would be unsuccessful or whether operative reduction would be successful without resection.     

巨结肠类缘性疾病肛管测压、直肠黏膜活检和钡灌肠检查的意义

目的　根据病理学的诊断依据 ,评价先天性巨结肠类缘性疾病 (HAD)中直肠肛管测压、直肠黏膜活检AchE组化染色和钡灌肠检查的特点 ,了解其在诊断上的意义。方法　 1999～ 2 0 0 1年间 92例临床诊断为先天性巨结肠 (HD)或巨结肠类缘性疾病并施行手术的患儿 ,根据病理诊断排除HD和HAD共存病变病例 ,筛选出HD 4 0例 ,其中男 36例 ,女 4例 ,平均年龄 2 1个月 ;HAD 34例 ,其中男 2 1例 ,女 13例 ,平均年龄 6 3个月。研究二组的临床征候指标以及在经典的测压、组化以及钡灌肠三项检查上的差别。结果　二组病例相比 ,三项检查每项指标间都存在着极显著差异 (P <0 .0 1) :在HAD组患儿 ,85 %都存在有直肠肛管抑制反射 ,其反射波出现特征性的“W”、“U”波形 ;直肠黏膜AchE组化染色 79%为阴性 ;钡灌肠常不能发现明显的狭窄、移行段 ,但有明显的结肠扩张和2 4h钡滞留。结论　HD和HAD是都以便秘为主要表现的两种不同的疾病。经典的三联检查在HAD的诊断和鉴别上也具有重要意义     

婴儿阑尾盲肠多重套叠并急性阑尾炎一例并文献复习

目的 探讨婴儿期阑尾盲肠多重套叠并急性阑尾炎的临床病理和诊治方法.方法 回顾性分析1例阑尾盲肠多重套叠并急性阑尾炎8月龄婴儿的临床资料,并通过PubMed、ProQuest、中国知网(CNKI)、万方和维普数据库中检索2016年5月前的报道并复习相关文献资料,对各类儿童阑尾套叠进行系统性综述.结果 本例阑尾盲肠多重套叠并急性阑尾炎经手术诊断,整复套叠后切除阑尾并经病理证实,术后顺利康复.共检索到215例阑尾套叠中儿童52例,阑尾盲肠套叠136例,仅3例阑尾自身套叠中有2例为儿童;检索到肠套叠并阑尾炎66例,儿童59例,其中小于1岁的患儿27例,回结型肠套叠43例,此外,检索到回肠盲肠型套叠7例和盲肠盲肠型套叠并阑尾炎1例均为成人患者,所有病例均行手术治疗而痊愈.儿童阑尾盲肠多重套叠并急性阑尾炎者未见报道.结论 婴儿阑尾盲肠多重套叠并急性阑尾炎罕见,如套叠未导致回盲瓣排空完全梗阻则无典型症状体征,诊断困难,易误、漏诊.因此,对经保守治疗不能解除肠梗阻且不能解释其原因时,只要B型超声提示“同心圆征”或“套筒征”就应果断行手术探查以明确诊断并及时治疗.     

阑尾原位造口可控性顺行灌肠的临床评价

目的 评价阑尾原位造口顺行灌肠治疗神经源性大便失禁的临床疗效.方法 1998年6月至1999年12月间对13例伴有大便失禁的脊髓栓系综合征患儿,男9例,女4例,年龄6～13岁,全部施行阑尾原位造口附加阑尾套叠瓣手术,术后间断经阑尾造口插管灌肠.结果 13例均获随访,随访时间2～6年.4例分别于术后2个月、4个月、4个月、6个月停止灌肠后近2周发现造瘘口狭窄,2例经扩张治疗后狭窄消失,2例未行扩张,再2周后造瘘口闭塞.无发生造瘘口漏粪、漏气或插管困难,11例术后肛门功能明显改善.结论 应用阑尾原位造口施行顺行灌肠,可明显改善神经源性大便失禁患儿的肛门功能及生活质量,是一种理想的顺行灌肠方法 .     

髂腰肌盆底悬吊术结合Malone顺行灌肠治疗神经性大便失禁

目的 探讨髂腰肌盆底悬吊术结合Malone顺行灌肠治疗神经性大便失禁的临床价值。方法 选择由脊髓发育不良所致的神经性大便失禁14例（年龄4～13岁），均行双侧髂腰肌悬吊盆底加强术和阑尾造口术，术后配合顺行灌肠治疗。结果 14例获得随访6～16个月（平均10.4个月），术前术后临床主客观评分有显著性差异，术前术后直肠静息压无明显变化；直肠感觉阈、肛管直肠压差、肛管高压区长度和主动收缩压均有明显变化，2例因造瘘口狭窄未能坚持顺行灌肠。结论 髂腰肌盆底悬吊术结合Malone顺行灌肠是治疗神经性大便失禁的有效方法，可明显改善患儿的生活质量。     

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.     

超声和关节造影辅助下治疗儿童肱骨远端骨骺分离的临床疗效分析

目的:比较超声与关节造影辅助下闭合复位经皮内固定术治疗儿童肱骨远端骨骺分离的临床疗效。方法:收集2013年4月至2017年8月收治于华中科技大学同济医学院附属武汉儿童医院骨科的30例肱骨远端骨骺分离的患儿的相关资料。其中,男25例,女5例;平均年龄为20.7个月,年龄范围为10~38个月;患侧为左侧10例,右侧20例。...     

Accuracy of ultrasonography for the diagnosis of intussusception in infants in Vietnam

Background Intussusception (IS) is the most common cause of acute bowel obstruction in infants and young children. Ultrasonography is being increasingly used as the primary investigation for the diagnosis of IS and to guide air or hydrostatic enema reduction. However the accuracy of ultrasonography outside tertiary care settings in developed countries has not been assessed, particularly in Asia where the incidence of IS based on sonographic diagnosis has been reported as the highest in the world. Objective The aim of this study was to evaluate the accuracy of ultrasonography in the diagnosis of acute IS in infants less than 2 years of age in a paediatric hospital in Vietnam. Materials and methods A prospective study was conducted at the National Hospital for Paediatrics, Hanoi, Vietnam, over a 14-month period recruiting patients <2 years of age with IS. Abdominal ultrasonography was performed on each patient and the accuracy of the diagnosis was evaluated against the final diagnosis provided by air enema and/or surgery. Results A total of 640 infants <2 years of age presented with clinical symptoms and signs of IS. The diagnosis was confirmed in 533 patients via air enema or surgery. Abdominal ultrasonography was 97.5% (466/478) sensitive and 99% (106/107) specific in the detection of IS. Conclusion Ultrasonography is an accurate, safe and valuable clinical tool in the diagnosis of IS. The use of ultrasonography as a primary investigation for patients with suspected IS prevents unnecessary radiological or surgical procedures being performed, and reduces radiation exposure while maintaining a high level of diagnostic accuracy. These results validate the use of ultrasonography for the diagnosis of IS in a developing country setting.     

超声助显剂灌肠与X线钡灌肠在先天性巨结肠诊断中的应用价值

目的探讨超声助显剂灌肠与X线钡灌肠在先天性巨结肠诊断中的应用价值。方法以贵阳市妇幼保健院39例经直肠黏膜活检及手术病理确诊的先天性巨结肠患者为研究对象,同时行超声助显剂灌肠以及X线钡灌肠检查,对诊断结果进行对比分析。结果超声助显剂灌肠诊断先天性巨结肠阳性36例,真阳性率为92.3%(36/39)。根据狭窄痉挛段累及范围分型:常见型19例,短段型6例,超短型4例,长段型4例,全结肠型3例,漏诊3例。X线钡灌肠诊断先天性巨结肠阳性35例,真阳性率为89.7%(35/39),其中常见型18例,短段型5例,超短型3例,长段型4例,全结肠型5例,漏诊4例。超声助显剂灌肠以及X线钡灌肠检查诊断结果差异无统计学意义(P>0.05);两者联合诊断先天性巨结肠38例,诊断真阳性率为97.4%(38/39),其中常见型19例,短段型6例,超短型4例,长段型4例,全结肠型5例,漏诊1例。与单用一种检查方法相比,联合诊断真阳性率更高(P<0.05)。结论超声助显剂灌肠与X线钡灌肠在先天性巨结肠的诊断中均可提供较为可靠的影像学依据,二者均可作为常规无创检查手段。