超声下水压灌肠治疗肠套叠技术改进及评价

目的 通过对治疗肠套叠疾病气压和水压灌肠治疗结果统计分析,探讨气压灌肠和水压灌肠产生的压力对肠道及机体的影响;探讨两种方法的优劣;探讨治疗的安全性;探讨肠套叠的最佳治疗方案.方法 1996～2015年,20年间我院治疗肠套叠患儿1 249例,其中男818例,女431例.根据治疗方法不同,设三个时段分为三种方法:1996～2000年为X线气压灌肠阶段(方法①)173例;2001～2005年X线下气压灌肠向水压灌肠过渡阶段(方法②)220例,2006～2015年B超下水压灌肠阶段(方法③)856例.统计非手术治疗肠套叠整复率、失败率.结果 方法①、②、③总有效率分别为85.0％、86.8％、95.0％,总平均有效率88.9％;复位失败率分别为15.0％、13.2％、5.0％,平均失败率11.1％,方法②与①差异无统计学意义(P＞0.5),方法③与①、②相比,差异有统计学意义(P＜0.005).气压灌肠产生压力快不容易掌控,肠套叠整复率相对较低,易造成肠腔胀气及损伤,安全性差,而且在X线下操作对人体存在潜在性损伤;水压灌肠产生压力较缓慢,作用温和,可反复作用于套叠部位,整复率高,对肠道无明显影响,安全性有保障,而且在B型超声下监视操作对人体无明显影响.结论 B型超声监视下水压灌肠是目前治疗肠套叠疾病最佳的方法,具有操作简便、易懂、易学、易掌握的优点,避免了X线对人体伤害,整复率高,减少手术发生率,安全性高,是临床值得推广的项目,特别值得基层医院推广使用.

Technological improvements and evaluations of hydrostatic enema for intussusceptions during guided ultrasound

Objective To explore the therapeutic outcomes of intussusceptions by air enema and hydrostatic enema,analyze their effects on intestinal tract and body so as to summarize their advantages and disadvantages,discuss medical safety and seek the optimal therapeutics for intussusception.Methods There were 818 males and 431 females over the last two decades.According to different treatment methods during different periods,3 groups were designated:air enema under radiograph (method A,n =173) during 1996-2000,air enema under radiograph to transitional hydrostatic enema (method B,n =220) during 2001-2005 and hydrostatic enema under guided ultrasound (method C,n =856) during 2006-2015.Statistical comparison was made for nonoperative treatment with regards to reduction rate and failure rate.Results The overall effective rates of methods A,B and C were 85.0％,86.8％ and 95.0％,the overall average effective rate was 88.9％ and the failure rates were 15.0％,13.2％ and 5.0％ with an average of 11.1％.Methods B and A had no significant discrepancy or significance (P＞0.05).As compared with methods B and A,method C had significant difference (P ＜ 0.005).The pressure from air enema passed through intestines so fast that it was difficult to control.It was susceptible to intestinal flatulence and injuries.It might cause potential damage to human body under radiography.On the contrary,hydrostatic enema was created more slowly than air enema.It could repeatedly act on the superimposed part so that it was more likely to succeed.Enema during guided ultrasound had no obvious impact upon intestinal tract.Conclusions Reduction of hydrostatic enema under guided ultrasound is a first-line option.Understanding,learning and handling it are quite convenient.And radioactive exposure is avoided.With a high rate of success and safety,it reduces the chance of surgery.Thus it is worthy of wider popularization at grass-roots.