成人肠套叠的特点及临床对策

目的：探讨成人肠套叠的特点和诊治对策。方法：回顾性分析35例成人肠套叠的临床资料。结果：(1)腹痛为最常见症状,共32例(92．4%),有腹部肿块者12例(34．3％),有血便者8例(22．9％);(2)术前确诊为肠套叠者9例(25．7%),肠梗阻13例(37．1％),腹部包块疑消化道肿瘤7例(20％),急性阑尾炎3例(8．6％);(3)引起肠套叠的病变有：小肠肿瘤21例(60．0％),美克尔憩室4例(11．4％),盲肠游离症4例(11．4％),结肠肿瘤3例(8．6%)等;(4)本组病例除1例结肠腺瘤性息肉行纤维结肠镜切除术外均行剖腹手术治疗,术后无严重并发症,无死亡病例。结论：(1)成人肠套叠大部分继发于小肠病变,且以小肠肿瘤最多;(2)近端空肠和回盲部是成人肠套叠的易发部位;(3)钡剂灌肠摄片、B超、纤维结肠镜有助于成人肠套叠的诊断,CT为最有诊断价值的检查;(4)治疗首选手术,术中应特别注意近端空肠和回盲部的探查。

Characteristics and Clinical Strategies of Adult Intussusception

Objective: To explore the characteristics and clinical strategies of adult intussusception. Methods: 35 cases with intussusception were retrospectively analyzed. Results: (1) Cases with abdominal pain in 32 cases (92. 4%) ,12 cases had a palpable abdominal mass(34. 3%), bloody stool in 8 cases(22. 9%), (2) Correct diagnosis was made for intussusception preoperatively in 9 cases (25. 7%). Other pre-operative diagnosis included: intestinal obstruction in 13 cases, abdominal mass suspected as intestinal tumor in 7 cases (20%), acute appendicitis in 3 cases, et al. (3) Causes of adult intussusceptions: small intestinal tumor in 21 cases (60%), Meckel's diverticulum (MD) in 4 cases (11. 4%), "cecum mobile" syndrome in 4 cases (11.4%), tumor of large intestine in 3 cases, et al. (4) All but one patient underwent laparotomy,all cases recovered uneventfully after operation. There was no mortality. Conclusion: (1) Most of the adult intussusceptions were secondary to primary lesion, and most of them were small intestine tumors. (2) Proximal jejunum and the ileocecal areas were the sites most commonly involved. (3) Ultrasonography, barium enema and colonoscopy are helpful in diagnosing adult intussusceptions, computed tomography (CT) proved to be the most useful diagnostic method. (4) Operative management is the first choice. More attention should be paid to the proximal jejunum and ileocecal areas during the laparotomy.