小儿肠套叠空气灌肠结合中医针灸整复及影响因素的探讨(附412例分析)

目的:分析小儿急性肠套叠的整复方法、中医针灸在整复中的作用及影响整复成功率的因素。方法:对412例肠套叠患儿进行空气灌肠诊断及整复,分别采用一般持续注气、持续+脉冲注气和持续+脉冲注气结合中医针灸方法整复。结果:一般持续注气整复68例,整复率为82.4%(56/68);持续+脉冲注气整复277例,整复率92.4%(256/277);持续+脉冲注气结合中医针灸整复93例,其中第一次整复67例,整复率100%(67/67);其他方法失败第2次整复30例,整复率78.7%(23/30)。结论:整复率与发病时间、肠套叠的类型及整复方法有关,持续+脉冲注气和持续+脉冲注气结合中医针灸整复率均较高,尤其是后者,肠套叠的类型与发病时间是影响肠套叠整复成功率的主要因素。     

小儿肠套叠空气灌肠整复的疗效及影响因素

目的：分析肠套叠空气灌肠整复不能复位的影响因素，提高整复成功率及安全性。方法：1997年-2001年间495例肠套叠中443例经空气灌肠整复，52例未整复成功经手术治疗（其中2例整复时穿孔）。整复压力6．5-12．5kPa（48．75-93．75mmHg）。165例肌内注射654-2约5mg。52例中年龄2月至13月，平均5．3月，发病6至70小时，平均32小时，31例超过24小时。结果：52例手术病例，27例有肠坏死；49例为复套，回-回-结型39例，回-盲-结型7例，回-回-盲-结型3例；35例套叠颈部较紧；29例套头大，呈分叶状；7例套入头部有原发病变。结论：89．5％小儿肠套叠可经空气灌肠整复。影响整复的因素有：发病时间；套叠类型；注气压力；解痉药物；整复器类型。     

空气压力灌肠整复小儿肠套叠（附286例分析）

小儿肠套叠是小儿常见急腹症之一,空气压力灌肠整复为首选治疗方法.影响肠套叠整复成功的因素有病程长短、肠套叠部位及其程度、患儿的全身情况、注气压力选择等[1].本研究回顾性分析了215例空气压力灌肠整复中采用间歇注气法辅以手法按摩整复的价值与71例采用一般注气法整复的比较及208例使用男性成人导尿管代替双腔气囊管(Foley管)与整复成功率的关系.     

有关小儿肠套叠空气灌肠复位的探讨

肠套叠（intussusception）是小儿外科常见的急腹症，是肠管的一部分及其相应的肠系膜套入邻近肠腔内的一种肠梗阻，在婴儿期尤其多见半岁至两岁间。非手术整复小儿肠套叠的方法较多，常见的有生理盐水、钡剂和空气灌肠整复法，其整复效果也不一。小儿肠套叠如能早期行空气或钡剂灌肠复位多获成功。据有关资料显示小儿肠套叠空气灌肠整复成功率89．0％（388／436）．其中病程≤24h，若在实施空气灌肠复位前给予盐酸山莨菪碱等舒张平滑肌的药物其成功率更高，曾就空气灌肠复位失败后手术的患者进行随访，有部分患者在给予麻药后打开腹腔套叠部位已自行打开，还有部分患者套叠部位已明显松弛，     

空气灌肠整复小儿肠套叠最佳时机的探讨

本文通过对46例小儿肠套叠实施空气灌肠整复治疗。整复前均经临床拟诊，X线灌肠证实，分别按照套叠后的不同时间进行统计分析：其中套叠0-24小时，22例，整复19例；24-36小时20例，整复20例；36-48小时4例；整复2例。文章从小儿肠套叠的病理变化、客观因素以及本组病例的统计分析，阐明了①整复小儿肠套叠的最佳时机应选在24-36小时之间；②严格掌握适应症、熟练的操作技术及正确的方法是整复成功的关键。     

空气灌肠治疗小儿肠套叠

肠套叠在小儿急腹症中是常见病,我科6年来共收治32例小儿肠套叠,采用空气灌注加手法按摩整复均达到良好效果,现将资料总结如下: 一般资料:32例中,男性14例,女性18例,年龄均在一周岁以内。从发生症状到就诊,最短为半小时,最长达16小时。套叠部位,回盲部21例,升结肠11例。     

儿童急性肠套叠的诊断性空气灌肠治疗(附198例分析)

目的分析空气灌肠整复肠套叠的影响因素,提高整复成功率.方法作者回顾性分析了采用自动控制压力肠套叠复位机对198例儿童急性肠套叠进行的200例次空气灌肠,并辅以手法按摩,就其整复成功率与病程、套头所在部位、全身情况及方法的关系进行了统计学分析和讨论.结果198例儿童急性肠套叠,回结型160例(80.8%),盲结型21例(10.6%),结结型17例(8.6%),空气灌肠复位率为83%.肠套叠整复成功率随病程的延长(2～24h为93.6%、24～36h为78.6%、36～48h为64.9%、48～72h为50%)及套叠程度的加深(升结肠末端以近为91.9%、肝曲～横结肠末端为76.1%、脾曲～降结肠为67.4%)而降低,经卡方检验(Ρ＜0.001),整复成功率与患儿的全身情况(如发热、脱水程度)及整复方法有密切关系.结论只有综合分析影响空气灌肠整复肠套叠的各种因素,掌握好适应证,才能提高儿童急性肠套叠的复位成功率.     

经纤维结肠镜行肠套叠吹张整复术9例

1990年开始我们应用CF－LB2型纤维结肠镜对9例结肠套叠施行吹张整复治疗，7例获得成功，现报告如下。1临床资料1．1一般情况本组均为男性。年龄：2～6岁4例；27～66岁5例。发病时间：2～6h2例；7～12h3例；12～24h3例；24～48hi例。肠套叠类型：回肠结肠套叠7例，结肠结肠套叠2例。原发性肠套叠6例，继发性肠套叠3例。7例在应用本法治疗前曾进行过钡灌肠检查明确诊断，其中3例曾经作过气钡灌肠整复失败而改行本法治疗。1．2方法术前肌注所替惯50～75ms，阿托品O．3～0．5mg，并作清洁灌肠。小儿可在基础麻醉F进行。将肠镜插入病变部位，…     

小儿肠套叠空气灌肠诊疗体会

目的：小儿肠套叠空气灌肠诊疗的体会和应用价值。方法：2000年1月-2005年12月本院对126例临床诊断肠套叠的患儿进行空气灌肠诊断与整复，整复未成功者行外科手术。结果：空气灌肠整复成功112例，整复成功率88．9％，其中14例复位失败后改行手术治疗。结论：小儿急性肠套叠只要符合适应症并无其他并发症；空气灌肠为小儿急性肠套叠首选且经济的治疗方法。     

小儿肠套叠钡灌肠X线表现及在整复中的体会

目的：探讨小儿肠套叠钡剂灌肠X线表现与整复的关系，认为钡剂灌肠与空气灌肠整复同样具有高安全性、高整复率的优点，对未整复成功的病例进行了临床分析。材料与方法：总结了2003年1月至2005年11月，经钡剂灌肠确诊的小儿肠套叠46例，年龄3个月至3岁，以6个月至1岁患儿多发，发病时间8h至4d，主要临床表现：患儿哭闹不安，呕吐，血便，腹部可触及包块；全部病例在灌肠前做了腹透，发现有肠梗阻征象就摄片；用日立XF130型800mA胃肠X线机，容量300ml至400ml带气囊灌肠器，灌肠压7KPa至14KPa（52．5mmHg至105mmHg）进行灌肠。结果：钡剂灌肠X线片上1．梗阻端为“杯口”状改变，本文43例，其中41例整复成功，整复率89．1％；尚有2例，因发病时间长3d至4d，精神差，疑有肠坏死，未整复。2、梗阻端为“分叶”状及“弹簧”状改变，本文分别为1例和2例，整复失败；在整复过程中均无一例肠破裂穿孔。结论：通过对41例整复成功和5例整复失败小儿肠套叠的钡剂灌肠，结合有关资料表明，只要患儿，1、发病时间短48h内，体质好；2．无复杂性套入；3、无合并器质性病变；无论是钡剂灌肠还是空气灌肠均能达到安全性高、整复率高的目的。     

山莨菪碱在小儿肠套叠空气整复中的应用

目的 探讨山莨菪碱在小儿肠套叠空气整复中的作用。方法 常规空气灌肠不能整复的患儿550例，经肌注山莨菪碱5mg，20～30min后再行试灌。结果 468例整复成功，82例未成功，其中2例穿孔，行手术治疗。结论 空气整复小儿肠套叠应用山莨菪碱是一种简易有效的方法，值得推荐。     

提高小儿肠套叠空气灌肠整复成功率及预防并发症的探讨

目的:提高小儿急性肠套叠空气灌肠整复成功率及预防并发症。方法:对268例临床诊断为急性肠套叠患儿进行空气灌肠整复。结果:空气灌肠整复成功252例(94%),其中24例经2次整复成功,2例在术前麻醉后第三次整复成功,失败16例。结论:空气灌肠是诊断与治疗小儿肠套叠的最好方法,不仅能有效地提高整复成功率,还能避免并发症的发生。     

Recurrent ileocolic intussusception with appendiceal lead point in a 2-year-old child: an etiology to be aware of on ultrasound

Ileocolic intussusception is a differential consideration in young pediatric patients presenting with acute abdominal pain. Appendiceal intussusception is an uncommon variant of ileocolic intussusception where the appendix is contained within the intussusception, which can be challenging to diagnose preoperatively. In this case report, we present a 25-month-old female presenting with intermittent, diffuse abdominal pain. Initial ultrasound evaluation demonstrated ileocolic intussusception, which was successfully reduced by air enema. The patient experienced recurrent symptoms and had several recurrent episodes of ileocolic intussusception with the appendix contained within the intussusceptum. After the fifth recurrence, the patient underwent surgical intervention. The inflamed appendix was discovered to be inverted within the cecum, resulting in a lead point for intussusception of the terminal ileum. The patient underwent laparoscopic reduction of the ileocolic intussusception and appendectomy. Few cases of appendiceal and concurrent ileocolic intussusception are described in the literature. It is important that radiologists and surgeons be aware of this entity when evaluating pediatric ileocolic intussusception, particularly at the time of ultrasound and air enema, in order to ensure appropriate management and prevent complications.     

Intussusception in children: US-guided pneumatic reduction--initial experience

PURPOSE: To assess the feasibility and effectiveness of ultrasonography (US)-guided pneumatic reduction of intussusception in children. MATERIALS AND METHODS: The study group consisted of 49 consecutive patients (aged 2 months to 7 years; 36 boys, 13 girls) who underwent 52 reductions of intussusception during 9 months. Intussusception was diagnosed in all patients with the known US criteria, and all patients underwent a US-guided pneumatic reduction attempt wholly within the US examination room. A pressure of 60 mm Hg was maintained for 30 seconds, with US guidance. The procedure was considered to be successful when US showed the disappearance of the intussusceptum and the edematous terminal ileum with an abrupt transition into the normal proximal ileum. When the intussusception was not reduced, the procedure was repeated, with pressure increased to 120 mm Hg. RESULTS: The overall success rate of US-guided pneumatic reduction was 92% (48 of 52 reductions), with no immediate recurrence. Of the two patients who had intussusceptions that were irreducible, one had residual ileoileal intussusception at surgery, and the other had an ileal polyp as a lead point. Perforation occurred in two (4%) of 52 cases; one patient underwent right hemicolectomy due to bowel necrosis and had a pinpoint perforation in the normal proximal transverse colon, and the other underwent manual reduction of ileoileocolic intussusception, with microperforation in the proximal transverse colon. CONCLUSION: US-guided pneumatic reduction seems to be a feasible and effective method for the treatment of intussusception in children because of its radiation-sparing effect and high success rate.     

小儿肠套叠空气灌肠复位影响因素探讨

目的 分析空气灌肠治疗小儿肠套叠的各种影响因素。方法 对117例确诊肠套叠的患儿，采用双腔气囊外接压力计或不接压力计，在X线透视下行空气灌肠。结果 117例中，完全复位92例(78％)，复位失败17例(14．5％)，不完全复位8例(6％)。结论 空气灌肠是治疗小儿肠套叠的重要方法，其影响复位成功与否的因素，主要有套入时间、类型、复位方法等。     

Intussusception: the use of delayed, repeated reduction attempts and the management of intussusceptions due to pathologic lead points in pediatric patients

OBJECTIVE: The nonoperative management of intussusception continues to evolve and is the subject of ongoing debate. Our purpose was to assess our current enema reduction rate and to focus on two specific issues that have received little attention in the literature: first, the value and safety of using delayed, repeated reduction attempts and, second, the management of intussusceptions due to lead points. MATERIALS AND METHODS: We performed a retrospective analysis of all intussusception cases seen at the Hospital for Sick Children, Toronto, Canada, a tertiary pediatric hospital, from May 1999 to December 2002. RESULTS: There were 163 children with a total of 219 intussusceptions. Enema reduction was attempted in 211 (96%). Reduction rate with air enema was 90.2%. Delayed reduction attempts were used in 25 patients (15.3%) in 26 intussusceptions (12.3%) and were successful in 50% of the cases. Lead points were documented in 13 children (8%); sonography depicted the lead points in seven (53.8%) of the 13. The reduction rate of intussusceptions due to lead points was 63.6% (14/22). CONCLUSION: Air enema associated with the use of delayed, repeated reduction attempts is a safe and effective approach for intussusception reduction with a high success rate. Delayed, repeated reduction attempts should be considered when the initial attempt manages to move the intussusceptum and the patient remains clinically stable. The management of intussusceptions due to lead points remains a challenge. Sonography does not depict all lead points, and the indication for other imaging studies should be tailored according to each particular patient. We recommend attempted enema reduction in all patients with lead points.     

延时再次空气灌肠复位术治疗小儿肠套叠(附145例分析)

目的:评估延时再次空气灌肠复位术在治疗肠套叠患儿中的疗效.方法:从2000年～2005年对145例肠套叠患儿行空气灌肠治疗.按照从发病到接受治疗的时间将患儿分为三组: A组＜12h,B组12～24h,C组＞24h.采用国产JS818E型电脑遥控灌肠整复仪在德国西门子Iconos R-200型数字胃肠机的监视下进行整复.结果:2000年～2005年所有病例空气灌肠整复的成功率为92%(145例中134例成功).2003年以前只实施单次灌肠复位,空气灌肠整复的成功率为85% (55例中47例成功),2003年后通过对初次灌肠失败者施行延时再次灌肠复位术,将成功率提高到97%(90例中87例)(P＜0.05).结论:延时再次空气灌肠复位术显著提高了肠套叠患儿肠管整复的成功率.     

Air enema for diagnosis and reduction of intussusception: clinical experience and pressure correlates

Air enema was used for exclusion, diagnosis, initial movement, and complete reduction of intussusception in 186 pediatric patients. Average pressure needed for initial movement of intussusception was 56.5 mm Hg; average maximum pressure of 97.8 mm Hg was required for complete reduction. Average fluoroscopy time required for intussusception reduction was 94.8 seconds; an average of 41.8 seconds was required to exclude intussusception. Intussusception was diagnosed in 75 patients, and reduction was accomplished in 65 (87%). Of 100 consecutive patients that underwent hydrostatic reduction of intussusception at the authors' institution, reduction was successful in 55. Compared with hydrostatic enema, air enema involves shorter fluoroscopy time and lower radiation dose to the patient. Air enema is safe and effective for diagnosis and treatment of intussusception in infants and children and has replaced hydrostatic enema for such procedures at the authors' institution.     

Sonographic detection of lymph nodes in the intussusception of infants and young children: clinical evaluation and hydrostatic reduction.

OBJECTIVE: Our aim was to assess the sonographic appearance of enlarged lymph nodes in the intussusception in infants and young children and to investigate whether the enlarged lymph nodes affect the hydrostatic reduction rate of intussusception. MATERIALS AND METHODS: This retrospective case control study included a total of 65 children with intussusception, consisting of two groups: a study group of 28 patients with lymph nodes detected in intussusception and a reference group of 37 patients of similar age without lymph nodes in intussusception. The selection criterion for the study group was the presence of a minimum of two lymph nodes, of which at least one had a long axis of 11 mm or greater. The intussusception patterns, target or doughnut-like, and the presence of trapped fluid in the intussusception were also evaluated. Clinical records were reviewed for associated disease. The reducibility of both study and reference groups was assessed and correlated with all the sonographic features mentioned. RESULTS: Twenty-two of the 28 patients in the study group and none in the reference group had a recent or a current history of gastroenteritis. The overall hydrostatic reduction rate was 46.4% in patients with enlarged lymph nodes in the intussusception and 81.1% (p < 0.005) in patients without enlarged lymph nodes in the intussusception. Larger rather than numerous lymph nodes significantly affected the reducibility rate. Most of the reference group patients had a hydrostatic reduction at first attempt, whereas a second attempt at hydrostatic reduction was required in most of the study group patients. CONCLUSION: Enlarged lymph nodes in the intussusception are mainly found in patients with a current or recent history of gastroenteritis and decrease the overall hydrostatic reduction rate.