Management of recurrent intussusception: nonoperative or operative reduction?

Purpose

The aim of this study was to determine how to manage children with recurrence of intussusception.

Methods

Medical records of patients treated for intussusception from 1976 to 2008 at the Queen Sirikit National Institute of Child Health were reviewed. Information on patients who developed recurrent intussusception was extracted to study patterns of recurrent attack and suitable management procedures. The statistical differences were analyzed by the χ² and the Student t test, with a P value < .05 considered significant.

Results

During the study period, 1340 patients were treated for 1448 episodes of intussusceptions, with an average of 40 cases per year. There were 108 episodes of recurrent intussusception in 75 patients (45 males and 30 females). The overall recurrence rate was 8%. Patient age at the first episode ranged from 3 months to 12 years (average, 14.9 months). The time interval before each recurrence ranged from 1 day to 3.2 years (average, 7.8 months). The number of recurrences ranged from 1 to 5 attacks. Recurrent intussusception occurred in 35 (15.8%) of 222 children following successful hydrostatic barium enema (BE) reduction and in 55 (11.4%) of 482 after successful pneumatic or air enema (AE) reduction. There was no statistical difference between the recurrence rates after the 2 nonoperative procedures (P = .08). Recurrent intussusception developed in 14 (3.0%) of 457 patients after operative manual reduction. Recurrence was not observed after intestinal resection for initial irreducible intussusception in 175 patients. The remaining 4 recurrent episodes occurred after spontaneous reduction. Of the 108 episodes of recurrence, BE and AE reductions were successful in 25 (96.2%) of 26 attempts and in 57 (92%) of 62 attempts, respectively. Seven patients had their first episode of intussusception treated surgically. All 7 when they recurred were successfully treated with either BE or AE reduction. Operative intervention was needed in 23 episodes of recurrent intussusception; 18 were reduced manually, and 5 required intestinal resection. Overall, 7 (9.3%) of the 75 recurrences had a pathologic lead point: colonic polyps in 4 cases and Meckel diverticulum in 3 cases. There were no deaths among the 75 patients with recurrent intussusception.

Conclusions

Recurrent intussusception should be initially treated by nonoperative reduction. Laparotomy is needed in cases with failure of BE or AE reduction, in cases with suspicion of a pathologic lead point, and in selected cases with several episodes of recurrence. The treatment of recurrent intussusception, in general, should be similar to that of primary intussusception.     

食醋保留灌肠联合东莨菪碱治疗肝性脑病的研究

目的 分析食醋保留灌肠联合东莨菪碱治疗肝性脑病患者的临床疗效.方法 选择在本院接受住院治疗的肝性脑病患者作为研究对象,分别接受单纯东莨菪碱（对照组）及食醋保留灌肠联合东莨菪碱治疗（观察组）,比较两组治疗效果及血氨、MDA、SOD水平差异.结果 观察组患者治疗有效率（94.9％）明显高于对照组;血氨水平[（211.4±32.2）μmol/L]、MDA水平[（4.4±0.8）μmol/L]明显低于对照组,SOD水平[（47.3±8.6） U/mg]明显高于对照组（P＜0.05）.结论 食醋保留灌肠联合东莨菪碱可以有效提高肝性脑病患者的治疗效果,降低血氨水平.     

5-氨基水杨酸保留灌肠治疗慢性溃疡性结肠炎280例观察

目的探讨5-氨基水杨酸保留灌肠治疗慢性溃疡性结肠炎的临床效果。方法分别采用5-氨基水杨酸保留灌肠（0.9%NaCl-60ml＋5-氨基水杨酸制剂4 g,保留灌肠,Qd）和常规治疗法（0.9%NaCl-60ml＋氢化可的松100mg,保留灌肠,Qd）对慢性溃疡性结肠炎患者进行治疗,比较其治疗效果。结果 5-氨基水杨酸保留灌肠治疗可加快慢性溃疡性结肠炎患者粘液脓血便及腹泻症状的缓解。但对患者的腹疼症及里急后重症状的治疗,两组方法无明显差异。5-氨基水杨酸保留灌肠治疗法能够有效提高慢性溃疡性结肠炎患者的治疗有效率（其有效率为98.58%）。结论针对慢性溃疡性结肠炎患者采用5-氨基水杨酸保留灌肠治疗,可明显提高患者的治疗有效率,加快部分临床症状的缓解。     

改良保留灌肠治疗慢性盆腔炎的临床效果分析

目的探讨改良保留灌肠治疗慢性盆腔炎的效果。方法选择2012年5月-2013年12月收治的慢性盆腔炎患者120例,随机均分为对照组和观察组,对照组采用传统保留灌肠法治疗,观察组采用改良保留灌肠法治疗,观察两组的临床治疗效果,统计两组的插管成功率、管道脱出率、药物外泄率及患者肛门疼痛率。结果观察组总有效率为90．0％,对照组总有效率为75．0％,观察组总有效率明显高于对照组,差异有统计学意义（P〈0．05）：观察组1次插管成功率高于对照组,管道脱出率、药物外泄率及患者肛门疼痛率明显低于对照组,差异有统计学意义（P〈0．05）。结论改良保留灌肠治疗慢性盆腔炎效果较好,可延长药物保留时间,减少管道脱出情况及患者不适感,值得临床应用。     

清肝利肠灌肠液合煎与分煎对大黄5种游离蒽醌含量的影响

目的：比较清肝利肠灌肠液合煎液与单煎液中芦荟大黄素、大黄酸、大黄素、大黄酚和大黄素甲醚的含量变化.方法：采用高效液相色谱法,色谱柱为Kromasil 100-5C18（250 mm×4.6 mm,5 μm）,甲醇-0.1%磷酸溶液为流动相进行梯度洗脱,流速1.0 ml·min-1,检测波长254 nm.结果：芦荟大黄素、大黄酸、大黄素和大黄酚的在清肝利肠灌肠合煎液中的含量分别为0.172 8,0.662 5,0.233 0,0.173 9,0.052 9 mg·g-1;在单煎液中的含量分别为0.215 2,1.201 0,0.307 6,0.326 6,0.051 5 mg·g-1.结论：芦荟大黄素、大黄酸、大黄素和大黄酚的含量清肝利肠灌肠液单煎液高于合煎液,而大黄素甲醚的含量合煎液高于单煎液.     

B 超引导下水压灌肠治疗小儿肠套叠的临床应用简

目的：总结B超引导下水压灌肠治疗小儿肠套叠的临床经验。方法：对144例经B超引导下水压灌肠整复小儿肠套叠整复前后患儿的临床资料及治疗效果进行分析。结果：复位前144例均有阵发性哭闹、呕吐、解果酱样血便表现,复位后症状消失139例;复位前腹部可触及异常包块100例,复位后异常包块消失97例;复位前144例B超均能探及腹部异常包块,复位后异常包块消失139例;碳剂实验144例（6-8h）排便有碳剂139例,无碳剂排出5例;B超诊断符合率100%,复位成功139例,复位成功率96.5%。结论：B超引导下水压灌肠治疗小儿急性肠套叠操作简便、易行,成功率高,可作为小儿急性肠套叠首选的诊断、治疗方法,值得临床借鉴。     

中药灌肠治疗溃疡性结肠炎的疗效分析

目的 探讨中药灌肠治疗溃疡性结肠炎的临床疗效.方法 收集我院2013年1月至2015年3月收治的溃疡性结肠炎患者80例前瞻性研究且随机分为两组,每组40例,对照组患者给予柳氮磺吡啶,实验组患者则加施中药灌肠,比较两组患者治疗前后主要症状评分、整体治疗效果与镜下观粘膜情况等.结果 实验组患者治疗后各症状评分与对照组组间比较差异具有统计学意义(P＜0.01);实验组患者治疗总有效率(90.0％)明显高于对照组(75.0％),两组比较差异具有统计学意义(P＜0.05);实验组患者镜下观粘膜炎症(15.0％ vs.37.5％)、粘膜水肿(7.5％ vs.27.5％)、粘膜充血(5.0％ vs.22.5％)、溃疡(2.5％vs.17.5％)与糜烂(0 vs.12.5％)明显少于对照组,两组比较差异具有统计学意义(P＜0.05).结论 中药灌肠治疗溃疡性结肠炎的临床疗效显著,具有借鉴性.     

灌肠在胸外科术前准备中的应用

目的　探讨灌肠在胸外科术前准备中的应用价值。方法　选择 2 0 0 3年 2月至 2 0 0 4年 1月接受肺切除手术患者 96例 ,随机分为试验组和对照组 ,每组各 48例。对照组采用常规胸外科手术术前准备 ;试验组在常规术前准备的基础上 ,术前晚以洁达甘油灌肠剂 110ml灌肠。统计术后 3d内出现腹胀、便秘人数 ,统计学方法采用 χ2 检验。结果　试验组术后出现腹胀 2例 (4 .17% ) ,便秘 3例 (6.2 5 % )。对照组术后腹胀 10例 (2 0 .83 % ) ,便秘 11例 (2 2 .92 % )。两组比较差异有显著性 (P <0 .0 5 )。结论　对于胸部手术病人 ,术前灌肠可有效地减少术后腹胀、便秘 ,有利于患者术后恢复 ,具有一定的应用价值。     

中药保留灌肠结合常规治疗高血压脑出血昏迷临床观察

目的:观察中药保留灌肠中西医结合干预高血压脑出血昏迷患者对意识改善情况及并发症控制的临床疗效.方法:将确诊的80例患者随机分为两组各40例,对照组采用常规西医脱水降颅压及对症支持治疗等措施.治疗组在对照组治疗方法的基础上给予中药保留灌肠,14天后观察意识障碍改善情况及并发症发生率.结果:格拉斯哥昏迷评分(GCS)治疗组(12.10±3.66)分,对照组(9.15±4.21)分,两组比较,差异有显著性意义(t=3.344 5,P＜0.01);治疗组退热时间缩短(t=-12.745 1,P＜0.01);重症肺炎(x2=4.052 5,P＜0.05)、高热(x2=10.453 3,P＜0.01)及肾功能不全(x2=11.428 6,P＜0.01)并发症发生率明显低于对照组.结论:中西医综合疗法对高血压脑出血昏迷患者意识障碍有明显的改善作用,并能有效控制并发症的发生.     

银甲汤灌肠治疗慢性盆腔炎临床观察与护理

目的:观察银甲汤灌肠治疗慢性盆腔炎的临床效果及护理方法。方法:对50例慢性盆腔炎患者行银甲汤灌肠治疗,观察其治疗效果并采取相应的护理。结果:患者行银甲汤灌肠治疗后,总有效率显著高于口服对照组,疗效短于口服组,副作用少于口服组(P<0.05)。结论:银甲汤灌肠治疗可作为治疗慢性盆腔炎的一种方法。