系统化护理在空气灌肠复位治疗小儿肠套叠患儿中的应用体会

目的观察系统化护理在空气灌肠复位治疗小儿肠套叠中的应用效果。方法对40例应用空气灌肠复位治疗的小儿肠套叠患者,实施心理护理、病情观察、并发症预防及出院教育等系统化护理。结果本组患儿一次性复位成功36例(90.00%),2例经2次复位成功,2例复位失败患者经中转手术治疗成功复位。患儿均获随访6个月,无复发病例。结论空气灌肠整复小儿急性肠套叠安全、有效。在空气灌肠复位治疗过程中实施系统化护理能提高复位成功率,减少并发症发生。     

152例小儿肠套叠空气灌肠法及复位治疗体会

目的 探讨如何增加空气灌肠整复小儿肠套叠的成功率及并发症预防.方法对152例小儿肠套叠患者行空气灌肠整复的过程及失败的原因作回顾性分析.结果 152例患者中,空气灌肠复位成功126例,失败1例,25例未见肠套叠征象,复位后并发症主要是发热,腹泻,血便,腹痛,复套.结论空气灌肠是诊断与治疗小儿肠套叠的最好方法,能有效地提高复位率,复位失败者不宜强行复位,应及时手术治疗,避免并发症的发生.     

空气灌肠复位治疗小儿肠套叠的护理体会

目的总结空气灌肠复位治疗小儿肠套叠的护理体会。方法回顾性分析35例急性肠套叠患儿实施空气灌肠复位的护理资料。结果 33例患儿经空气灌肠复位成功,2例复位失败患儿转手术复位成功。治疗期间未发生肠穿孔等并发症及死亡病例。出院后均获6个月随访,未出现复发病例。结论对实施空气灌肠复位的急性肠套叠患儿实施规范护理,可提高复位成功率,减少并发症发生率。     

影响急性肠套叠X线下空气灌肠复位相关因素的对比研究

目的总结分析小儿急性肠套叠病例,提高小儿急性肠套叠的X线下空气灌肠复位成功率和减少并发症。方法选取2013年以来近3年资料完整、诊断明确急性肠套叠600例,进行相关因素的统计学分析,从而找出小儿急性肠套叠X线下空气灌肠复位的影响因素。结果本组600例,实施空气灌肠586例,成功544例,失败42例,手术53例,无死亡病例,X线下空气灌肠治疗肠套叠总体成功率为92.83%。术中发现继发性肠套叠10例;患儿的年龄、血便的量、腹胀、X线下包块的形状、发病时间以及病理类型是影响肠套叠空气灌肠复位成功与否的重要因素,肥胖、发热对肠套叠复位无明显影响。结论小儿急性肠套叠年龄小、发病时间长、血便量大、腹胀、套叠位置深在等复位率低;回回结型肠套、形态呈分叶状不宜强行复位;全身状况差的患儿复位时需谨慎,低压力试行复位失败后尽早行手术治疗,从而达到提高复位成功率、减少并发症的目的。     

非透视下空气灌肠诊治小儿肠套叠

本组非透视下空气灌肠诊断与治疗小儿肠套叠56例。对临床资料进行回顾性分析,应用常熟东方医用器械厂SWB—B型自动肠套叠复位仪非透视下操作,其中46例复位成功,1例患儿复位3次治愈。10例手术治疗,术后感染1例,伤口哆开,二次于术再度腹腔感染死亡。结果:非透视下空气灌肠复位操作简单,无需X光机,恢复良好,无复发,远期效果满意。     

小儿肠套叠38例临床分析

目的探讨小儿肠套叠的诊治措施,提高小儿肠套叠的诊断及治疗水平。方法收集2016-12—2018-04间在西平县人民医院和漯河市第二人民医院就诊的38例肠套叠患儿的临床资料,进行回顾性分析。结果 38例肠套叠患儿均有哭闹不安(腹痛)、拒乳、呕吐、果酱样大便及腹部包块等临床表现,均经腹部超声明确诊断。36例(94.74%)患儿在X线透视下应用空气灌肠成功复位。2例空气灌肠复位失败的患儿转小儿外科成功手术复位。治疗过程中均未发生肠管穿孔及坏死等并发症。出院后随访6～12个月,无1例复发。结论超声诊断小儿肠套叠具有较高的准确性,且操作简便、经济、安全。在严格掌握适应证的前提下,在X线透视下应用空气灌肠,不仅可作为诊断方法,也是一种有效的治疗方法。对空气灌肠不能复位,或病期已超过48 h,或怀疑有肠坏死,或灌肠复位后出现腹膜刺激征及全身情况恶化的患儿,应及时转小儿外科手术治疗。     

空气灌肠治疗38例小儿肠套叠效果分析

目的分析空气灌肠治疗38例小儿肠套叠效果。方法对收治的38例小儿肠套叠实施空气灌肠并观察治疗效果。结果 38例患儿中34例(89.47℅)均一次性成功复位,4例手术成功复位。结论对小儿肠套叠实施空气灌肠,创伤小、复位成功率高。     

小儿肠套叠47例临床治疗分析

目的总结小儿肠套叠的诊断及治疗体会。方法回顾性分析47例肠套叠患儿的临床资料。结果本组患儿中行空气灌肠44例,其中42例(87.2%)整复成功。手术治疗5例(含空气灌肠整复失败2例),其中行套叠肠管切除Ⅰ期肠吻合术3例(2例合并Meckel憩室),行套叠肠管复位术2例。本组患儿住院期间无近期并发症发生,均治愈出院,无死亡病例。随访3¹8个月,无远期并发症发生。结论早期诊断,合理实施治疗手段是提高小儿急性肠套叠治愈率和改善预后的重要保证。     

解痉补液通便腹外推挤法在小儿肠套叠空气灌肠复位中的应用

目的探讨提高小儿肠套叠空气灌肠整复率的相关方法。方法对2006年1月至2009年7月间312例肠套叠患儿随机分2组进行空气灌肠复位,对照组常规法空气灌肠复位,观察组先解痉补液通便再在复位过程中加入腹外推挤法。结果常规法空气灌肠复位154例成功140例,成功率90.9%;先解痉补液通便再在复位过程中加入腹外推挤法空气灌肠复位158例成功153例,成功率96.8%。结论采用先解痉补液通便再在复位过程中加入腹部外推挤法空气灌肠复位可提高复位成功率。     

腹腔镜手术治疗小儿急性肠套叠36例报告

目的:总结腹腔镜手术治疗小儿急性肠套叠的手术经验。方法:2008年8月至2011年5月为36例空气灌肠复位失败或禁忌的肠套叠患儿行腹腔镜手术。腹腔镜直视下行肠套叠复位术,如发现复位困难,则行空气灌肠辅助复位。如复位仍失败,可经Trocar将吸引器头或细硅胶管插入肠套叠鞘部,注入生理盐水,在空气灌肠辅助下用无损伤抓钳牵拉回肠末端,整复肠套叠,复位后行腹腔镜阑尾切除术。如有肠坏死或器质性病变,则行肠切除、肠吻合术。结果:22例经空气灌肠辅助复位成功,8例经鞘内注入生理盐水辅助复位成功。30例复位成功的患者均行腹腔镜阑尾切除术;3例因肠坏死或套叠过紧无法在腹腔镜下复位,2例美克尔憩室,1例淋巴瘤,行腹腔镜辅助肠切除、肠吻合术。手术时间平均45min,腹腔镜阑尾切除术时间平均8min,术后48h肠功能恢复,平均住院5d。随访至今,未见复发及手术并发症发生。结论:腹腔镜肠套叠复位术结合空气灌肠、肠套叠鞘部注水可使绝大多数肠套叠复位,手术安全可靠,具有腹腔镜手术的微创优点,复位后行腹腔镜阑尾切除术,不做回肠固定,可有效防止肠套叠复发。     

Laparoscopic treatment of Meckel's diverticulum

We present two cases in which complication of a Meckel's diverticulum were dealt with, and in one case diagnosed using the laparoscope. One was a large bleeding diverticulum containing ectopic gastric mucosa, with the diagnosis suggested preoperatively, confirmed laparoscopically, and the pathology resected extracorporeally. The second was a partial intermittent small-bowel obstruction due to torsion around the mesodiverticular band, diagnosed and resected via the laparoscope. The literature of Meckel's diverticula and complications is reviewed, with open and laparoscopic treatment options. Although uncommon, many cases of Meckel's diverticulum may be quite suitable for laparoscopic diagnosis and treatment.     

Meckel's diverticulum in laparoscopic era

A recent case of a Meckel's diverticulum diagnosed and successfully laparoscopically treated, triggered off a retrospective study on a series of 34 cases with Meckel's diverticulum admitted to the First Surgical Clinic between 1990-2003. We encountered 12 uncomplicated cases and 22 cases with a large panel of complications: 11 intestinal obstructions (volvulus 9, intussusceptions on a tumor-2), 9 cases with diverticulitis, 1 gastrointestinal bleeding and 1 case with Littre's inguinal hernia. Positive diagnosis was established intraoperatively and the surgical treatment was adapted according to the local situation (excision of the diverticulum or enterectomy). Out of 12 patients with uncomplicated Meckel's diverticulum 8 were subjected to prophylactic excision of the diverticulum. In 6 of these microscopic examinations were inclusions of gastric mucosa. Laparoscopy is safe, relatively inexpensive and efficient in the diagnosis and treatment of Meckel's diverticulum.     

Laparoscopic management of symptomatic Meckel's diverticula: a simple tangential stapler excision.

BACKGROUND: Meckel's diverticulum was first described about 400 years ago and continues to be a rare congenital disorder. Laparoscopic surgery for Meckel's diverticulum has been described in mostly case reports. We present our series of patients with symptomatic Meckel's diverticulum. METHODS: We have treated 12 patients with symptomatic Meckel's diverticulum from 1994 through 2006 at our institution. All the patients presented with features of either appendicitis or peritonitis, some with a vague abdominal mass. Clinical diagnosis of Meckel's diverticulum was made in only 4 patients. Diagnostic laparoscopy confirmed Meckel's diverticulitis in all patients. Laparoscopic stapler resection of the lesions was performed for all patients, tangential excision in 10 and wedge excision in 2. RESULTS: The incidence of Meckel's diverticulum at our institution is 0.3%. The majority of patients were male children. There were no staple-line leaks in any case. All patients recovered well postoperatively, and the day of discharge was in the range of the fourth to the seventh POD. Heterotopic gastric mucosa was found in the majority of the diverticula. Eight patients were followed up for 24 months, and 4 patients reported for follow-up after 45 months and were found to be symptom-free. DISCUSSION: The diagnosis of Meckel's diverticulitis is rarely made preoperatively. Surgical resection is indicated only if the diverticulum is symptomatic or if the base is narrow. Traditionally, open wedge resection (including the anterior wall of the ileum) of the diverticulum is the treatment. We think that a simple tangential stapler resection can also be performed, with good outcome. CONCLUSION: Laparoscopy is useful in both diagnosis and treatment. Laparoscopic resection of Meckel's diverticulum is feasible and ideal, especially when performed in specialized centers.     

Leiomyosarcoma of the Meckel's diverticulum and multiple diverticulosis of the ileum. Apropos of a case

We report a case of a leiomyosarcoma arising in a Meckel's diverticulum in a man of 90 years, with multiple ileal diverticulosis. The clinical picture was similar to acute appendicitis and diagnosis was not made until resection of an abdominal mass with histological appearance of leiomyosarcoma. 59 cases of leiomyosarcoma of Meckel's diverticulum have previously been reported in the literature. No case until now has been reported in a patient of Caribbean origin neither in association with ileal diverticulosis. Although rare, leiomyosarcoma is the commonest sarcoma of Meckel's diverticulum, and with full resection of the tumor the prognosis is very good.     

Stromal tumor of Meckel's diverticulum--a rare source of gastrointestinal bleeding and a real diagnostic problem

Although Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, complications in adults are rare, especially in the elderly. Lower gastrointestinal bleeding as a result of Meckel's diverticulum with ectopic gastric mucosa is unusual among the elderly. The case we report involved a 69 year old man with gastrointestinal hemorrhage found to be due a stromal tumor developed on Meckel's diverticulum. We considered our case interesting because of its rarity and of preoperative diagnosis difficulty.     

有并发症的成人Meckel憩室的急诊手术治疗:附29例报告

目的 探讨成人Meckel憩室并发症的临床特点，诊断和治疗。方法 回顾性分析急诊手术的29例成人Meckel憩室的临床资料。结果 18—30岁的患者占79．3％。憩室出血12例(41．4％)，急性化脓性憩室炎9例(31．0％)，憩室穿孔6例(20．7％)，憩室致肠梗阻2例(6．9％)。术前经小肠造影结合^99mTcO4-r核素扫描明确诊断4例(13．8％)，误诊25例(81．2％)。29例均行手术治疗，28例治愈，1例死亡。结论 成人Meckel憩室并发症容易误诊为阑尾炎等疾病。对下腹疼痛病人，尤其是年轻患者，若有下消化道出血，应想到Meckel憩室的可能性。小肠造影结合核素扫描是诊断憩室及憩室出血的有效方法。有并发症的Meckel憩室应尽早手术．并选择适当的手术方式。     

成人美克耳憩室49例诊治分析

目的探讨成人美克耳憩室的临床表现、诊断及治疗方法,以提高成人美克耳憩室的诊治水平。方法对我院1995年4月~2005年4月收治的成人美克耳憩室49例的临床资料进行回顾性分析。本组病人均经手术治疗。其中,行憩室切除加小肠部分切除32例,憩室切除加小肠楔形切除11例,腹腔镜辅助憩室切除加小肠部分切除6例。结果本组病例病理检查结果显示,美克耳憩室内有异位胃组织者21例,有异位胰腺组织者2例。本组病例均治愈出院。随访6月~10年,疗效满意。结论成人美克耳憩室主要表现为下消化道出血、急性憩室炎或小肠梗阻,无论有无临床症状,一经确诊,均以手术治疗为宜。腹腔镜可作为诊断和治疗成人美克耳憩室引起消化道出血的常规方法。     

Abdominal disorders arising from 71 Meckel's diverticulum

BACKGROUND AND AIMS: The study was done to investigate the frequency of Meckel's diverticulum, and its manifestations as the cause of abdominal disorders. MATERIAL AND METHODS: The material consisted of 71 patients with Meckel's diverticulum treated in our hospital during the years 1988-1998. From the material the age and sex were analyzed as well the outcome of patients. The histological findings of diverticulectomies were evaluated. RESULTS: In a retrospective analysis 46 males (65.5%) and 25 females (34.5%) were found. At the same eleven-year study period Meckel's diverticulum was found during 55 out of 3758 appendicectomies (1.5%). The age of patients ranged from 11 months to 87 years (mean 30.4 years). Preoperatively the diagnosis was made in three cases: two patients with TC-99m scanning and one patient with intestinal passage radiography. 46 Meckel's diverticles were asymptomatic, but 25 (34.5%) cases were symptomatic. Nine patients had ulcer in the diverticulum, which was perforated in five cases. Eight patients had intestinal occlusion, five patients had Meckel's diverticulitis, two patients had invagination, and in one case a sharp piece of plastic material had perforated the Meckel's diverticulum. CONCLUSION: Meckel's diverticulum should be searched in the laparotomy due to acute abdomen. It can be the cause of serious abdominal complications.     

成人美克尔憩室致肠梗阻的诊治

目的总结成人美克尔憩室致肠梗阻的外科诊治特点。方法对11例成人美克尔憩室致肠梗阻的病例进行回顾性分析。所有病例均表现为无明确诱因的急性肠梗阻,其中9例为完全性梗阻(5例发生绞窄),2例为不完全性梗阻。临床特点是起病急、进展快、易出现肠绞窄。内疝是形成梗阻的主要原因。结果全组11例均经手术探查证实诊断并进行治疗,憩室直径平均1.8(1.2~2.3)cm,长度平均5.1(3.5~7.0)cm。2例行憩室单纯切除,9例行小肠部分切除术,全部治愈。结论美克尔憩室致肠梗阻为外科急症,进展迅速且非手术治疗效果不佳。凡无明确诱因的成人(尤其是青壮年)急性肠梗阻均应考虑到本病,并应积极剖腹探查。术前无需进行过多的特殊检查。详尽的病史资料对诊断很有帮助,CT扫描有助于鉴别回盲部肿瘤所致肠梗阻。     

Fish bone perforation of Meckel's diverticulum: a rare event?

Foreign body perforation of Meckel's diverticulum is a very rare event. We report two cases of fish bone perforation of Meckel's diverticulum that presented within 5 days of each other. Both patients presented with acute abdomen and were initially suspected to have acute appendicitis. The diagnosis was only made at surgery when the appendix was found to be normal and Meckel's diverticulum was found to be inflamed and perforated by a fish bone. Both cases were treated successfully with Meckel's diverticulectomy.