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。     

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。     

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。     

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。     

96例小儿急性肠套叠空气灌肠复位治疗体会

目的 总结10年来小儿急性肠套叠空气灌肠复位进行经验教训。方法 对96例小儿急性肠套叠空气灌肠复位回顾性分析。结果 空气灌肠复位成功76例,并发穿孔1例,20例转手术治疗。结论 发病时间短,空气灌肠复位成功率高,超过24小时;诊断性空气灌肠复位,全身情况好,再次灌肠复位提高成功率,仪器设备改进对复位成功率有一定影响。     

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。     

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.     

改良空气灌肠法在小儿肠套叠的诊断和治疗的应用(附84例分析)

目的探讨改良空气灌肠法在诊治小儿肠套叠的临床应用价值。方法对我院在2000年1月至2006年12月采用改良空气灌肠法对84例小儿肠套叠的诊治资料进行回顾性分析。结果本组确诊为肠套叠84例,排除非肠套叠24例,明确诊断率为100%。复位成功79例,复位率为94.28%。复位未成功并手术治疗5例,其中3例是肠坏死1例为回回结肠型肠表叠,1例为Meckle憇室。复位后无并发症发生,然后随访有3例复发,其中1例复发4次,最后手术证实为Meckle憩室所致。本组在诊治过程无死亡病例发生。结论早期使用整复仪空气灌肠有助于提高肠套叠的诊断和复位率。采用中压、脉冲、间歇手术按摩改良法室气灌肠灌肠复位是种安全和有效的治疗措施。     

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。     

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。     

小儿急性肠套叠诊治回顾

目的　总结小儿急性肠套叠最有效的治疗方法。方法　对 1984年 8月～ 2 0 0 1年 8月在本院治疗的小儿急性肠套叠 2 3 45例总结回顾。结果　空气灌肠整复 2 2 2 8例 ,灌肠失败手术复位 117例 ,其中术中证实为特发性肠套叠者 79例 ,器质性病变伴肠套叠 3 8例。结论　空气灌肠是目前小儿急性肠套叠整复的最有效方法之一。     

Intussusception: barium or air?

At The Hospital For Sick Children, the use of air has recently replaced the use of barium in the reduction of intussusceptions. The purpose of this study was to review the results from 200 consecutive patients with intussusceptions, 100 patients treated with barium enema and 100 patients treated with air enema. The groups were similar with regard to sex, average and median ages, and presenting symptoms and signs. Successful reduction was achieved in 75% of episodes of intussusception treated with barium enema and 76% treated with air enema. Failure of either modality showed a high association with the presence of either a lead point or an ileoileal or ileoileocolic intussusception. Among those cases of unsuccessful reduction, operation was performed in all 59 cases; resection in 30 cases, manual reduction in 19, and spontaneous reduction was found in 10. There were three perforations during attempted reduction with barium and two with air. All perforations were treated by resection and primary anastomosis. There were 18 recurrent intussusceptions following barium enema reduction and nine following air enema reduction. Therefore, with the lower absorption of x-rays by air and the relatively inert nature of air (compared with barium in the event of a perforation), we feel that air enema is the treatment of choice in the initial management of intussusception.     

彩色多普勒超声对小儿肠套叠的诊断价值(附76例报告)

目的探讨彩色多普勒超声在小儿肠套叠诊断中的应用价值。方法 76例肠套叠患儿经彩色多普勒超声检查,探讨其超声影像学特征。结果 76例患儿均查见边缘清晰、界限清楚、回声不均的腹部包块,横切面呈"同心圆征"或"靶环征",纵切面呈"套管征"或"假肾征";同时8例包块上方见肠管扩张,且肠蠕动减弱或亢进,合并肠壁水肿;68例患儿测得肠壁血流信号,空气灌肠复位成功,8例未测得血流信号,空气灌肠复位成功4例,另4例转手术治疗;16例肠系膜淋巴结肿大,淋巴结边缘清晰、分界清楚、形态规则、皮髓质清晰。结论彩色多普勒超声在小儿肠套叠诊断中,准确率高,可重复性好,同时为非侵入性检查,对患儿无创伤,无辐射,操作简便,值得推广应用。     

Ultrasound-guided hydrostatic reduction for the treatment of idiopathic intestinal invagination

The more extended conservative treatment in intussusception consists of the accomplishment of fluoroscopy guided neumoenema. The development of the echography has allowed to introduce this as alternative in diagnosis and treatment of intussusception. Our objective is to analyze the therapeutic value of echography during resolution of intussusception with saline solution enema in pediatric patients. Intestinal intussusception was diagnosed in 183 patients by echography during a period of 7 years. Patients are classified in three groups according to treatment by means of opaque enema, radioscopy guided neumoenema or echography guided hydrostatic reduction enema. The results of the three series are analyzed: rate of failure of the procedure, the recurrences or the presence of complications. We exclude n = 18 patients that were operated on directly after the diagnosis. The reduction rate was 81.25% (9/16) with opaque enema; 94.6% (103/110) with neumoenema and 96.4% (27/28) with echography guided saline enema. Complications appeared in n = 2 cases of intestinal perforation, 1 with barium and 1 with air 2. Recurrences were n = 3, n = 2 with neumoenema and n = 1 with echography guided enema. Echography guide saline enema has a high security and effectiveness (96.4%), similar to the other methods, avoiding the exposition to ionic radiation. The technique is safe and it does not increase the rate of recurrences.     

Atypical intussusception

A series of 257 children with intussusception was studied with special regard to so-called atypical cases. Half the children were treated as outpatients and 106 patients were operated on, with intestinal resection in 22. Two children died. The atypical cases were considered to be those with a spontaneous reduction between the attempt at barium enema reduction and the operation, a specific lesion, recurrence, and a chronic course. Spontaneous reduction was found both in cases where the barium enema reduction was considered doubtful or unsuccessful and in cases where no attempt at barium enema reduction was made because of marked intestinal obstruction or the poor general condition of the patient. Sedation may facilitate reduction and barium enema reduction probably should be tried more extensively. A specific lesion should be suspected in children older than 2 yr with small bowel obstruction. In recurrent intussusception a causative lesion was not found more frequently than at initial intussusception. Chronic intussusception was found in only two children, both with causative lesions.     

Hydrostatic reduction of intussusceptions caused by lead points

It is generally accepted that an intussusception caused by a lead point will not be reduced by hydrostatic barium enema. This was reported several years ago, and has continued to be a consistent finding, prompting us to attempt hydrostatic barium enema reductions of recurrent intussusceptions in infants and children and also in older children with a first intussusception. However, in the last 9 years we have treated five children whose ileocolic intussusceptions were caused by lead points but which were reduced by hydrostatic barium enema. The histories and physical examinations were not any different than those of the average pediatric patient with an intussusception. The ileocolic intussusceptions diagnosed by barium enema were reduced with adequate reflux of barium into the terminal ileum. However, a residual and persistent filling defect in the colon or ileocecal area made laparotomy mandatory. In all five cases, a lead point was found and resected. This experience has suggested to us that a residual intraluminal filling defect in the barium column following what appears to be adequate flooding of the terminal ileum should be interpreted as a lead point, and an indication for a laparotomy.