B超在小儿肠套叠诊断与整复中的应用

使用高频超声对52例小儿肠套叠患儿进行诊断和超声监视下生理盐水灌肠复位。发现超声不仅可作为诊断肠套叠的方法，而且可在实时超声图像的监视下进行复位，如采用二维超声监视下，水压灌肠治疗小儿急性肠套叠，安全，效果较好，有取代X线监视下空气或钡剂灌肠整复治疗的趋势，值得推广。     

B超监视下水灌肠治疗小儿急性肠套叠47例

1992年 4月至 1998年 3月 ,笔者在 B超监视下行水灌肠治疗小儿急性肠套叠 4 7例 ,效果满意 ,现报告如下。资料与方法 :4 7例患儿中 ,男 3 6例、女 11例 ,年龄 3个月至 4岁 ,发病时间 2～ 4 8小时。均经临床和 B超检查确诊。常规肌注复方氯丙嗪 ,对腹痛频繁且较重者肌注阿托品。患儿安静后取头低足高位、仰卧 ,经肛门插入 1根气囊 ( Foleg)肛管 ,气囊充气 ;将 T型管一端接 Foleg管 ,侧管接血压计监视注水压力 ,另一端接注水器。在 B超监视下 ,用注水器将 3 7～4 0℃等渗盐水以均匀的速度推入肠内 ,注水压力 6.6～12 k Pa,注水量 3 0 0～ 8…     

超声对小儿肠套叠的诊断价值

目的探讨彩色多普勒超声小儿肠套叠的超声声像图特征及其诊断价值。方法回顾性分析85例小儿肠套叠的声像图表现、病史和临床表现,并总结出其声像图特征。结果85例小儿肠套叠中有77例为典型的特征性的肠套叠声像图,声像图表现为横切面呈"同心圆"征,纵切面呈"套筒"征;另8例肠套叠声像图不典型,声像图表现为"假肾"征和不规则型肿块。结论超声检查是诊断小儿肠套叠的首选影像学诊断方法。     

空气灌肠整复治疗小儿肠套叠96例报告

2003年3月～2005年9月，我们应用空气灌肠整复治疗小儿肠套叠96例，效果良好。现报告如下。 临床资料：96例肠套叠患儿中，男70例．女26例1年龄4个月～4岁，其中〈2岁者83例。手法复位证实为回一结肠型套叠80例，回一回型套叠10例，整复失败者6例改行手术治疗，证实为回一回结肠型套叠。     

X射线透视下空气灌肠辅助手法整复小儿肠套叠的应用

[目的]观察采用x射线透视下空气灌肠辅助手法整复小儿肠套叠疗效。[方法]使用适当的空气压力灌肠辅助以按摩的手法整复小儿肠套叠。[结果]80％的小儿肠套叠患者避免了有创性手术，应用该方法得到了良好的治疗效果。[结论]空气复位是目前最安全、实用、有效的治疗小儿肠套叠的手段。     

如何提高小儿肠套叠空气灌肠复位率的一点体会——手法整复

目的用手法整复辅助空气灌肠治疗小儿急性肠套叠,以提高其复位成功率。方法本组102例选择气压在8~12.5kPa之间,当套头在肠管内受阻,单纯空气灌肠复位效果欠佳时,采用双手全腹按压、局部套头按摩、单手套头推压来降低脱套阻力。结果 5例于结肠脾区受阻,16例于结肠肝区受阻,6例于升结肠区受阻,75例于回盲部受阻,经由手法整复后,95例复位成功,7例开腹手术,其中3例回回结型,2例回结型均出现肠坏死,1例为美克尔憩室,1例为恶性淋巴瘤。结论手法辅助空气灌肠治疗小儿肠套叠,双手全腹按压、局部套头按摩、单手套头推压可明显矫正肠腔内弯曲,与手术复位原则一致,缓解套入部痉挛、水肿、粘连,降低脱套阻力以加速肠套叠复位,从而有效提高复位成功率。     

儿童肠套叠空气灌肠整复141例

目的总结儿童肠套叠空气灌肠复位的经验．方法回顾分析１４１例（１４５次）儿童肠套叠空气灌肠整复率和其中２５例灌肠复位失败的情况．所有病例对整复率与病程、套叠部位、全身情况（肠梗阻、脱水）的关系进行了统计分析．结果本组１４１例空气灌肠整复率为８２７％，统计学分析表明．整复成功与否与病程长短（＜２４ｈ为９２７％，４８ｈ～９６ｈ为５０１％），套叠部位远近（肝曲近侧为９２５％，降结肠到乙状结肠为５３３％），患儿全身情况（有无肠梗阻、脱水程度）有紧密关系．影响空气灌肠整复成功与否有多种因素，两种以上因素组合较单一因素更能预示灌肠复位的难易，认真选择适应证，提高整复技巧，将能提高整复率．结论儿童肠套叠空气灌肠１４１例１４５次，整复率８２７％．     

小儿肠套叠应用空气或钡灌肠加压整复对比分析

目的 评价小儿肠套叠在X线电视监视下进行空气灌肠加压整复方法与钡剂灌肠加压整复方法的临床应用价值.方法 对86例经临床、X线检查确诊的小儿肠套叠分别进行空气灌肠加压整复38例,钡剂灌肠加压整复48例.结果 空气灌肠加压整复方法达到完全整复35例,不能整复3例,整复成功率为92.11%;钡剂灌肠加压整复达到完全整复48例,整复成功率为100%.两组比较,差异有统计学意义(X2:3.93,P＜0.05).结论 小儿肠套叠采用钡剂灌肠加压整复方法具有较高临床应用价值.     

B超诊断肠梗阻的分析

目的分析肠梗阻超声图象的特征，提高诊断率．方法使用阿洛卡630型超声诊断仪、探头频率3．5MHz，全部病例为直接扫查法，患者行仰卧位，全腹扫查，为避免肠气干扰，适当加压探头，并经腹部两侧进行扫查，观察肠袢有无扩张，肠腔内积液及肠袢蠕动的情况．结果肠管扩张，小肠直径在3．2cm～4．3cm之间，肠管积气积液为形态不定的强回声光团，其后方逐次衰减，积液显示为无回声浪性暗区，内有浮动的强回声光点，可见液体无回声及气体点状回声的游动和往返流动，肠壁显示清楚，厚度为0．8cm，其中1例扩张肠管横切呈“同心圆征”强弱交错排列的环带，纵切呈“套筒征”．结论肠梗阻可由多个不同原因引起，其特点是肠内容物不能顺利通过肠道，造成了一系列的病理变化及图象特征性改变，梗阻发生后，肠腔内吸收液体减少或不吸收，使肠道积液，超声正好利用液体造声特点，清晰显示肠管有无扩张，肠壁变化，肠蠕动及肠内容物在肠管内游动现象，为肠梗阻做出诊断．肠管扩张严重处多认为梗阻部位．B超还是诊断肠梗阻的一种较好的诊断方法．     

28例肠套叠整复体会

1999年4月至2004年3月，我们共收治肠套叠患儿28例，27例整复成功。现介绍成功整复体会。     

Effectiveness of pneumatic reduction of ileocolic intussusception in children.

A total of 158 consecutive therapeutic air enemas were performed upon 133 patients during a 2-year period. Perforation and/or an impairment of the general condition of the children were the only main contraindications for the reduction attempt (five patients). Successful reductions were achieved in 89% of cases with no complications. Operation was performed in all 17 cases of unsuccessful reduction: resection in four cases, easy manual reduction in nine, difficult manual reduction in two, and spontaneous reduction in two. There were 16 (12%) patients with one or more recurrent episodes. In 23 (16%) cases, following pneumatic reduction, a swollen ileocecal valve showing a multiple appearance was observed. This fact sometimes results in a differential diagnosis with incomplete reduction; in all these cases, small bowel aeration was always a sign of complete reduction. No significant difference was noted between a swollen ileocecal valve and patient age, duration of symptoms, presence of small bowel obstruction, and further recurrences. Air enema has improved our previous success obtained with hydrostatic reduction (79%), as well as being a simpler, cleaner, and faster technique for intussusception reduction in children.     

The assessment of colonic water retention prior to double-contrast enema

The detection of colonic water retention prior to double-contrast enema (DCE) was studied in 41 outpatients. Ultrasound examination of the cecum (USC) correctly showed 4 of the 5 patients with water retention as well as all 14 cases with dry colon. Changes in patient's weight or in the number of cleansing enemas were not associated with water retention. The USC seems to offer a rapid and accurate method for the detection of colonic water retention prior to DCE. Aspects of the handling of colonic water retention are also discussed.     

Serum electrolyte, mineral, and blood pH changes after phosphate enema, water enema, and electrolyte lavage solution enema for flexible sigmoidoscopy.

Hypertonic sodium phosphate (Fleet) enema is a commonly used preparation for fiberoptic flexible sigmoidoscopy. Unfortunately, Fleet has been associated with complications in children and adults. The purpose of this study was to compare the serum electrolytes, mineral, and blood pH changes before and after the administration of Fleet with water and polyethylene glycol electrolyte lavage solution (Golytely) as enemas in an adult population undergoing flexible sigmoidoscopy. Sixty-six patients were randomized in a double-blind fashion to receive two enemas of either Fleet (N = 22), water (N = 20), or Golytely (N = 24). The cleansing ability was graded from 1 to 4 (1 = poor, 4 = excellent). The Fleet had significantly better optimal cleansing efficacy compared with water (p < 0.05) but not to Golytely (p > 0.05). There was a significant increase in the serum phosphorus in the Fleet group compared with water (p < 0.001) or Golytely (p < 0.001). However, absolute serum phosphorus values after Fleet enema always remained within normal range in all but one patient. The changes in other electrolytes, minerals, and venous pH were insignificant.     

Successful management of adult lymphoma-associated intussusception by laparoscopic reduction and appendectomy

Although primary gastrointestinal lymphoma is a rare malignancy, it can cause an intussusception in adults and can be a clinically challenging condition to manage. Intussusception could progress to lifethreatening complications if left untreated or could delay chemotherapy if inappropriate surgical management is used. We report a 31-year-old man diagnosed with human immunodeficiency virus who was being treated with antiretroviral therapy. He presented with nausea, vomiting, poor appetite, and intermittent, cramping abdominal pain for over 1 wk. Abdominal computed tomography revealed a well-defined homogeneous mass in the mesenteric root region, together with a long segmental wall thickening in the ileum with ileocolic-type intussusception, which was suspected to be caused by a lymphoma. The intussusception was successfully laparoscopically reduced, and the tumor involvement of the appendix was confirmedby appendectomy with intraoperative frozen section. Systemic chemotherapy was immediately initiated after surgery without the need for bowel resection.