针灸配合空气灌肠整复小儿肠套叠的研究

目的:探讨针灸配合空气灌肠在整复小儿肠套叠中的价值。方法:取足三里、合谷、天枢、中脘、关元等穴位,毫针直刺,深度0.5-1寸,用泻法,配合空气灌肠治疗小儿肠套叠。结果:32例肠套叠针灸配合空气灌肠复位成功31例,占96.8％。结论:针灸结合空气灌肠提高了肠套叠的整复率,是小儿肠套叠诊断、治疗的首选方法。     

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。     

超声引导下温生理盐水灌肠在小儿肠套叠整复过程中影响因素分析

小儿肠套叠是临床儿科常见的急腹症之一.目前诊断和治疗方法主要有空气、气钡灌肠整复和超声引导下水灌肠整复以及有创的外科手术治疗.近年来浙江省乐清市人民医院在超声引导下,用温生理盐水灌肠并加以手、探头双合诊在诊治小儿肠套叠中效果显著,整复成功率明显提高.现收集2005年～2010年1月乐清市人民医院超声引导下诊断和治疗的213例肠套叠患者资料,分析影响小儿肠套叠整复的因素,以进一步提高小儿肠套叠整复的成功 率.     

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。     

小儿肠套叠气压整复的临床应用分析

目的：通过对85例小儿肠套叠气压整复的临床观察，分析肠套叠的坏死征象，从而提高肠套叠诊断准确性和整复率，减少灌肠并发症。材料和方法：近三年来，用气钡灌肠机确诊小儿肠套叠共85例，分析小儿肠套叠气压整复的体会和成功率。结果：85例确诊小儿肠套叠，除7例伴肠坏死，2例严重淤血水肿未能整复外，其余76例(90％)全部整复，无出现灌肠并发症。结论：基层医院要注意抓住肠坏死特有X线征象，避免或减少灌肠并发症为重点。采用简便安全的整复术，可提高整复率，有极好临床应用疗效。     

针灸配合钡灌肠整复小儿肠套叠的探讨

肠套叠是婴幼儿常见急腹症，发病年龄多为2岁以下。常规钡灌肠复位成功率较低，危险性高。作者自97年2月～2002年2月采用针灸配合钡灌肠提高了肠套叠的整复成功率，现分析报道如下。     

注重放射防护 保护儿童健康——读《针灸配合气或钡灌肠整复小儿肠套叠的研究》有感

周波等为提高小儿肠套叠气或钡灌肠复位率,缩短复位时间,减少所受辐射剂量,自1995年以来配合针灸对32例进行疗效对照观察,取得了一定的疗效,达到了很好的麻醉、镇痛、复位效果.笔者为放射诊断人员学习运用中医理论并付诸实践所取得的成绩感到十分高兴(见中国中西医结合影像学杂志,2004;2:244-246),感慨颇多.笔者于40年前即开展了气或钡灌肠整复小儿肠套叠的研究,当时由于生活条件的原因肠套叠发病率特别高,几乎每个夜班都要接诊2～3个病例.而且也曾用过针灸和低压间隙注气来提高治愈率.当时曾发动全昌潍地区十几个县、区医院放射科医生推广应用,作者还撰文作为典型事迹介绍.此间曾搜集各县、区医院几年来4 000余例的实践经验,由山东人民出版社于1975年出版了作者的处女作<肠套叠空气灌肠整复法>.其后围绕这一课题先后发表过10余篇论文,有的还在全国放射学年会上宣读,当时实在自觉非常满意.     

臭氧混合气体灌肠治疗小儿肠套叠的应用探讨

目的:探讨臭氧与空气混合气体灌肠治疗小儿肠套叠的临床应用价值。方法:搜集本院采用臭氧与空气混合气体灌肠治疗小儿肠套叠的46例患儿(臭氧组)的病例资料,与采用传统空气灌肠治疗的102例患儿(空气组)进行对照分析。结果:臭氧组45例1次复位成功,1例2次复位成功,复位成功率为100%(46/46),一次复位成功率为97.8%(45/46);空气组83例1次复位成功,9例2次复位成功,10例复位失败,复位成功率为90.1%(92/102),一次复位成功率为81.4%(83/102)。两组比较复位成功率,差异有统计学意义(χ2=4.82,P<0.05),一次复位成功率差异亦有统计学意义(χ2=7.34,P<0.01)。臭氧组辐射剂量平均值为(3.56±1.36)mSv,空气组辐射剂量平均值为(5.82±2.25)mSv,两组比较差异有统计学意义(P<0.05)。结论:采用臭氧与空气混合气体灌肠治疗小儿肠套叠,整复率高,患儿辐射剂量小,明显优于传统空气灌肠方法。     

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.     

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。     

Comparison of oxygen and barium reduction of ileocolic intussusception

Reports that gas reduction of ileocolic intussusception has a better success rate than traditional barium reduction prompted us to evaluate this technique and to compare the results with our previous experience with barium. Our method of intussusception reduction uses oxygen at a flow rate of 2 l/min and with a maximum pressure of 80 mm Hg. The results of 65 consecutive patients with 69 episodes of intussusception over a 9-month period were retrospectively reviewed. For eight episodes, gas enema was not used, including six patients who had barium reduction during the introduction of the gas technique and two patients in whom no intussusception was seen during gas enema were excluded. In the remaining 61 episodes, six patients were considered to be unacceptable risks for attempted therapeutic reduction with either oxygen or barium, according to our current criteria, and had primary surgery. Enemas with oxygen were attempted in 55 cases and were successful in 40 (73%). If all 61 cases with confirmed intussusception are included, the overall success rate with oxygen was 66%. We had greater success with oxygen than with barium (73% vs 53%), although identical pressures were used and the number of severely ill patients referred for therapeutic enema (90% vs 60%) had increased. The change in the referral pattern reflects the adoption of less conservative criteria for excluding patients from having therapeutic enema. No complications have occurred to date. We have had greater success with the use of oxygen than with that of barium, and have had no complications. Therefore, at our institution, oxygen has superseded barium for the therapeutic reduction of ileocolic intussusception.     

Therapeutic enema for pediatric ileocolic intussusception: using a balloon catheter improves efficacy

A therapeutic enema for pediatric intussusception may benefit by using a rectal catheter with an inflated balloon. We compared the efficacy of rectal catheters without and with an inflated balloon for air and liquid enemas. We retrospectively reviewed PACS images and hospital records of children who had a therapeutic enema for intussusception at our institution between January 2006 and May 2011. Sixty-two enemas in 60 children were included. Physician assistants with training in pediatric fluoroscopy and pediatric radiologists were more likely to use air enema (37/41 or 90 %), and general radiologists were more likely to use liquid enema (18/21 or 86 %). However, the reduction rate for air enema overall was only slightly higher than for liquid enema using an inflated balloon catheter (36/40 or 90 % versus 14/17 or 82 %) (P?=?0.653). For air enema, mean procedure time for successful reductions was shorter with an inflated balloon catheter than with a plastic catheter (7.6 versus 28.2 min) (P?<?0.009), but the reduction rate was not affected. For liquid enema, the reduction rate was higher with an inflated balloon catheter than without inflation (14/17 or 82 % versus 1/5 or 20 %; P?=?0.021), but the procedure time was not shortened. No procedural complications were directly attributed to using a rectal catheter with an inflated balloon. Using a rectal catheter with an inflated balloon appears to safely shorten the procedure time of a successful air enema and improve the reduction rate of liquid enema.     

脉冲式空气灌肠治疗小儿肠套叠(附86例分析)

目的:探讨脉冲式空气灌肠治疗小儿急性肠套叠的临床价值和疗效。方法:经肛门插入Foley气囊导管,连接脉冲灌肠整复仪,先行诊断性空气灌肠,确诊为肠套叠后行脉冲空气整复,难复型结合手法按摩,本组病例气压选择在8~16KPa之间。结果:86例患者中,回—结肠型72例(83.7%),回—回—结肠型14例(16.3%),套头位于回盲部25例,升结肠17例,结肠肝曲14例,横结肠8例,结肠脾曲9例,降结肠5例。81例患者复位成功,成功率约94.2%。结论:脉冲式空气灌肠能减轻套叠部位的痉挛与水肿,提高肠套叠的整复成功率。     

Intussusception in infancy and childhood

Experiences of the diagnosis and treatment of 41 patients with intussusception are presented. The most common signs and symptoms upon presentation were vomiting (83%), colicky pain (83%), rectal bleeding (66%) and abdominal mass (51%). All four features occurred together in only 20% of cases. Ultrasound was the primary mode of investigation in four children, giving a finding characteristic of intussusception. 27 patients were examined with barium enema, and hydrostatic reduction was tried. A barium enema gave the correct diagnosis on all cases and a successful reduction of sign and symptoms in 12 patients (44%). In the other 29 cases laparotomy was performed to achieve reduction, primarily in 14 patients and after an unsuccessful barium edema in 15.84% of the patients presenting after a delay of more than 24 hours needed surgery, compared with 59% of those presenting earlier.     

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.     

Childhood intussusception: US-guided hydrostatic reduction.

Over a 30-month period, real-time ultrasound (US) was performed in 116 children with suspected intussusception. US findings were positive in all 75 cases of intussusception. Except in one case of transient small-bowel intussusception, the authors immediately attempted US-guided hydrostatic reduction in all cases. Reduction was successful in 63 cases (85%), as demonstrated with US and resolution of signs and symptoms of intussusception. Negative sonograms were confirmed with clinical follow-up. Among 11 failed cases, reduction with barium enema was attempted in six, but all attempts failed. No complications have occurred to date. The authors conclude that US is a reliable diagnostic screening modality in cases of suspected intussusception and that US-guided hydrostatic reduction is a promising technique in nonoperative treatment.     

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.