35例小儿肠套叠诊治分析

目的探讨小儿肠套叠的病因及诊治措施,提高肠套叠的治疗效果。方法对35例小儿肠套叠进行回顾性分析,其中男患儿28例,女患儿7例。结果非手术治疗12例,手术治疗23例,全部病例均治愈。结论小儿肠套叠的治疗效果与其就诊时间及灌肠早晚有一定的关系,应根据患儿病程时间长短及一般情况的好坏选择不同治疗方法。     

小儿肠套叠282例的诊治体会

为了提高对小儿肠套叠的诊治水平,对282例小儿肠套叠进行了回顾性分析总结。小儿肠套叠以1岁以内的发病率最高,男:女为1.7:1,春季发病占总数的41％。临床上以哭闹、呕吐、便血、腹块为四大主要症状。267例行结肠注气,219例复位成功,复位率82％。2例结肠注气时发生肠穿孔,穿孔率0.75％。手术患儿的套叠类型以回结型最多。本组患儿无一例死亡。     

178例小儿急性肠套叠诊治分析

目的探讨小儿急性肠套叠的诊断和治疗措施。方法对178例小儿急性肠套叠进行回顾性分析。结果行非手术治疗147例。手术治疗31例,其中6例行空气灌肠复位失败后手术。治愈176例,死亡2例。结论①根据临床特点,结合空气灌肠或B超检查可做出正确的诊断。②空气灌肠复位是最简单有效的复位方法,应根据病程长短及一般情况好坏选择不同的治疗方法。     

B超在小儿急性肠套叠诊治中的临床价值

目的 分析B超在小儿急性肠套叠诊治中的临床价值。方法 52例小儿急性肠套叠,男42例,女10例,全部采用B超诊断和B超下水压灌肠复位治疗。结果 临床诊断52例肠套叠患儿中,年龄5天～5岁,其中3～9月35例,诊断准确率100％;49例水压灌肠复位成功,治愈率94.2％,3例手术治疗。结论 B超诊断小儿肠套叠准确率高,B超下水压灌肠治疗小儿肠套叠技术简单、安全,疗效满意。     

小儿急性肠套叠82例诊疗观察

<正> 小儿急性肠套叠是引起婴幼儿急肠梗阻的常见原因之一,是小儿外科最常见的急腹症,易合并肠坏死、肠穿孔等严重的并发症,所以诊断和治疗的任何不当都会直接影响治疗效果。我院自1995～2001年收治82例,现报告如下。 1 临床资料 1.1 一般资料:本组男60例,女22例,年龄4～10个月46例(占56％),11～20个月28例(占34％),21～26个月8例(占9.7％)。发病时间最短4小时,最长3天。以阵发性哭闹或腹痛为首发症状者82例(100％),呕吐者62例(75.6％),便血者74例(90％),腹部可扪及肿块者67例(81.7％),腹肌紧张、拒按者14例(17％),腹胀者11例(13.4％);体温在37.0℃～38.0℃者36例,38.1℃～39.0℃者17例,39.1℃以上者7     

32例小儿重症急性肠套叠临床诊治分析

急性肠套叠是婴幼儿时期常见的急腹症,起病急,病情发展快,如不积极治疗,可发生严重的绞窄性肠梗阻,甚至危及生命。近8年来我们为32例发病时间较长的重症肠套叠患儿施行手术及综合治疗,收到了较为满意的疗效。现报告如下:1临床资料1.1一般资料:32例皆经手术证实为急性肠套叠,其中男23例,女9例,年龄:3个月1例,4～10个月21例,11个月～2岁7例,2岁以上3例;病程:48～60h26例,>60h6例。临床表现:有典型的阵发性腹痛、腹胀、红果酱样血便及腹部肿块者21例,8例未触及肿块。全部病例均有不同程度的脱水、酸中毒、腹胀、腹膜炎症状,甚至休克等表现。患…     

小儿急性肠套叠治疗分析(附418例报告)

通过总结分析小儿急性肠套叠418例,认为其处理要点是:①发病24～48小时行灌肠的对患儿一般情况要了解透切。出现高热、严重脱水休克、腹胀、腹膜刺激征,大量水样血便存在肠坏死可能,严禁复位。②透视下发现套叠肿块大,形成不规则,气体难以进入,避免强行增加压力复位。③空气灌肠压力从60mmHg开始逐渐增加不应超过120mmHg。④复位动作轻柔随空气进入按摩套叠肿块。⑤48小时以外,视患者一般情况而定,不强求空气灌肠复位。采用合理手术方式及正确手术操作预防措施,可以减少小儿死亡率及术后并发症。     

小儿急性肠套叠76例临床分析

目的 探讨小儿急性肠套叠的发病原因、诊断、空气灌肠复位及手术时机。方法 对76例小儿急性肠套叠的临床资料进行回顾性分析。结果 76例中71例经空气或钡剂灌肠均能明确诊断肠套叠。71例空气灌肠复位成功54例，占76．1％。外科手术22例中13例经手法复位成功；9例因合并肠坏死行肠切除吻合术，其中复合型套叠5例，回结肠型3例，回盲型1例。1例术后2d死于肺炎合并症，其余均治愈。结论 空气或钡剂灌肠小儿肠套叠早期或晚期症状不典型病例诊断有决定意义。技术操作不当是空气灌肠复位成功率低的主要原因。手术时机要根据发病时间结合具体情况具体分析作出选择，发病时间不能作为唯一依据。     

小儿肠套叠465例诊治体会

目的分析小儿肠套叠的临床特点、诊断及治疗。方法回顾性分析465例小儿肠套叠的临床表现、治疗效果。384例患儿空气灌肠治疗;81例手术治疗,并比较两种手术切口的愈合情况。结果465例小儿肠套叠的主要症状以腹痛、血便、呕吐和腹部肿块为主。空气灌肠法,操作简便,复位率可达82.58%以上;空气灌肠不能成功,需手术治疗,如能行麦氏切口较行腹直肌切口有优越性。结论小儿肠套叠早期诊断和治疗与预后相关。部分患儿手术可行麦氏切口。     

72例小儿急性肠套叠临床分析

目的 总结小儿急性肠套叠的诊断与治疗的经验和教训。方法 对72例小儿急性肠套叠进行回顾性分析。结果 发生小儿急性肠套叠以男性多见(62.5％)。好发年龄为3～6个月,回结型最多(73.6％)。空气灌肠复位成功24例,其余均手术治疗。徒手复位32例,肠切除吻合15例,单纯肠穿孔修补1例。术后合并切口裂开1例,切口疝1例,吻合口瘘3例。死亡1例,其余均痊愈出院。结论 早期诊断、尽快治疗是小儿急性肠套叠治疗成功的关键。在发病48小时内空气灌肠复位较容易成功,复位失败或发病时间长、病情较重者,必需手术治疗。     

小儿坏死性肠套叠外科治疗84例分析

目的 探讨小儿坏死性肠套叠的病因、诊断、低压空气灌肠复位的作用、手术治疗及并发症的防治。方法 对经手术治疗的84例小儿坏死性肠套叠进行回顾性分析。结果 本组原发性肠套叠73例,继发性肠套叠11例。套叠类型回-结肠型68例,小肠型12例,结-结肠型4例。全组均行套叠复位加坏死肠段切除一期吻合术。术前误诊5例,死亡3例。结论 ①局部解剖因素是小儿肠套叠发生的主要原因;②B超检查有助于肠套叠的诊断;③对于复发性肠套叠不宜反复多次地进行低压空气灌肠复位;④手术原则是对于高度怀疑肠管坏死的不能姑息,应积极切除,但同时亦应尽可能多地保留有活力的肠管及回盲瓣。     

Post operative recurrent acute jejuno-jejunal intussusception

A case of recurrent acute jejuno-jejunal intussusception presenting in the post operative period of the surgery for acute ileocolic intussusception is presented. Post operative intussusception is defined as intussusception occurring within 30 days of the primary surgery [1]. This is a rare entity. Jejuno-jejunal intussusception is also rare. Recurrent intussusception is uncommon. The present case is a combination of all these rarities.     

A special type of postoperative intussusception: ileoileal intussusception after surgical reduction of ileocolic intussusception in infants and children

Background

Postoperative ileoileal intussusception after surgical reduction of ileocolic intussusception in infants and children is extremely rare, and no reports of this special type of postoperative small bowel intussusception have been found in the literature.

Methods

We retrospectively reviewed the clinical charts of 6 infants and children with postoperative ileoileal intussusception that occurred after surgical reduction of ileocolic intussusception between January 1994 and December 2006. Clinical features, diagnostic strategy, operative findings, and outcome were analyzed.

Results

All 6 cases of postoperative ileoileal intussusception after surgery for ileocolic intussusception occurred within 1 week after the initial operation. The clinical manifestation was intestinal obstruction without abdominal palpable mass or bloody stool. Abdominal ultrasound examination revealed the target sign in 5 cases. Manual reduction of the intussusception was performed successfully at reoperation in each instance.

Conclusions

The clinical symptoms of postoperative ileoileal intussusception after operations for ileocolic intussusception are not typical. A second postoperative (ileoileal) intussusception should be kept in mind after surgical reduction of the first (ileocolic) intussusception in children. In any atypical postoperative ileus, a sonographic study should be done to rule out the diagnosis of postoperative intussusception. Once this condition is diagnosed, surgical treatment should be performed as soon as possible.     

Gastroesophageal intussusception: a new cause of acute esophageal obstruction in children

Gastrointestinal intussusception with obstruction is common in the small bowel and colon; however, such a process is not known to cause esophageal obstruction. Recent experience with gastroesophageal intussusception permits discussion of diagnosis and consideration of treatment options. A 3-year-old child presented with acute esophageal obstruction. Physical examination was significant for epigastric tenderness and excessive salivation. Chest x-ray showed a posterior mediastinal fullness. Esophagram documented a smooth crescent-filling defect, which caused obstruction of the esophagus at the level of the carina with proximal esophageal dilatation. Chest computed tomography of the thorax showed a soft tissue mass of the distal esophagus. Esophagoscopy confirmed occlusion of the midesophagus with the mucosa intact. A right thoracotomy permitted visualization of dilated proximal esophagus and a palpation of an intraluminal mass in the distal esophagus. Mobilization of the distal esophagus and gentle manual pressure cleared the obstruction to a point below the diaphragm. After a normal intraoperative esophagram, final treatment consisted of a longitudinal esophagomyotomy. The child recovered without complication and continues without recurrence for 18 months. This is the first report of gastroesophageal intussusception in children. Management by thoracotomy, manual reduction, and esophageal myotomy reestablished intestinal continuity and appears to eliminate recurrence; fundoplication or gastropexy may be alternative options. Preoperative recognition of gastroesophageal intussusception may allow nonoperative reduction or treatment by minimally invasive surgery.     

超声引导下水压灌肠复位治疗小儿急性肠套叠

目的探讨超声引导下水压灌肠对小儿急性肠套叠复位的疗效。方法178例小儿诊断为急性肠套叠,其中174例采用B超下水压灌肠复位治疗。结果178例肠套叠患儿中,168例复位成功,复位成功率94．4％,其中2例5天内共水压灌肠5次,10例转为手术治疗。结论B超下水压灌肠复位治疗小儿肠套叠疗效满意．水压灌肠技术简易,安全可靠,值得推广。     

Non-surgical treatment of jejunogastric intussusception

Summary Three cases of retrograde jejunogastric intussusception who were managed endoscopically are described. The diagnosis was made by means of endoscopy in one case and contrast radiology of the stomach in the other two. Endoscopic management consisted of reduction of the intussusception, followed by placement of a feeding tube deep in the intussuscepting segment. The patients responded very well and surgery could be avoided in all of them.     

A previously unmentioned surgical observation in the treatment of intussusception

(Received for publication on Apr. 20, 1998; accepted on Mar. 11, 1999)     

Spontaneous reduction of acute intussusception in children: Its incidence and significance in the diagnosis and treatment of recurrent intussusception

Five cases of acute recurrent intussusception in children are described in which spontaneous reduction occurred after one or more attacks. In three patients operation was carried out, the intussusception reduced and the appendix removed; in two no operation was performed. Clinical cure was observed in all cases with no further attacks for a significant interval.Analysis of these cases, as well as of thirty others culled from the literature, emphasizes the importance of recurrent intussusception as a cause of obscure abdominal complaints in children. The clinical manifestations, terminology, diagnosis and treatment have been briefly discussed.     

Clinical features and treatment outcome of intussusception in premature neonates

Background/Purpose: Less than 1.3% of all cases of intussusception occur in term neonates. Intussusception in premature neonates (IPN) is exceedingly rare. Its rarity and difficulty to differentiate IPN from common neonatal diseases like necrotizing enterocolitis (NEC) often delays its diagnosis. The authors set out to characterize diagnosis, treatment, and outcome of this rare condition.Methods: The authors analyzed 2 new cases of IPN and 33 previously reported cases from the literature.Results: The 35 patients with IPN had an average gestational age, postconceptual age at diagnosis, and birth weight of 28.4 ± 0.6 weeks (all data, mean ± SEM), 31.1 ± 0.5 weeks, and 1,165 ± 21 g, respectively. Gastrointestinal symptoms first presented at age 8 ± 1 days. A preoperative diagnosis of NEC was assumed in 24 patients, delaying diagnosis by 10 ± 2 days. Intussusception was diagnosed radiographically in 2 patients (1 contrast enema and 1 ultrasound scan) and during surgery or autopsy in the remainder. Resection was reported in 28 patients for bowel that was irreducible, necrotic, or perforated. The overall mortality rate was 20%, mainly owing to sepsis.Conclusions: Intussusception in the premature neonate often is misdiagnosed as NEC, delaying operative intervention. Contrast enema has limited diagnostic capability. Early diagnosis may be achieved with use of ultrasound scan. Intussusception can be treated successfully with resection and primary anastomosis, achieving good results.