小儿肠套叠的手术治疗

目的探讨小儿肠套叠的手术适应证、手术方式及并发症防治。方法回顾分析1971年1月至2008年12月316例小儿肠套叠患者手术临床资料，其中男186例，女130例。年龄〈6个月186例（58．9％）。病程〉3d247例（78．2％）。阵发性哭闹或腹痛306例（96．8％），呕吐277例（87．7％）。回结型112例（35．4％），回回结型118例（37．3％）。并发肠坏死116例（36．7％）。手术单纯复位200例（63．3％），行肠切除等术式116例（36．7％）。结果1例阑尾脓肿误诊为肠套叠，3例进腹后肠套叠已复位，因术后并发症再手术8例。治愈307例，自动出院2例，死亡7例。结论急性肠套叠目前绝大多数可经非手术治愈，手术应严格掌握指征，术式的选择要依患儿病变和耐受情况而定，加强围手术期的管理可望减少并发症。

Surgical operation of infantile intussusception.

Objective To explore the operative indication, procedure and postoperative complication of infantile intussusception. Methods Clinical data of 316 infants suffering intussusception in the past 38 years （ 1971- 2008） were reviewed. There were 186 male,130 female. One hundred and eighty-six patients （58.9% ,186/316） were younger than 6 months, and 78.2% （247/316） had suffered for more than 3 days. The proportion of abdominal intermittent pain and vomiting was 96.8 % （ 306/316 ） and 87.7 % （ 277/316 ）, respectively. Ileum-colon ascendens was 35.4% （112/316） and ileum-ileum-colon ascendens was 37.3% （118/316）. The proportion of intestinal nec- rosis was 36.7% （ 116/316 ）. Two hundred patients （ 63.3% , 200/316 ） were operated with simplified reposition and 36.7% （116/316） was operated with intestinal resection. Results One patient with appendiceal abscess was misdiagnosed as intussucseption. Three cases of intussusception had repositioned automatically during the operation. Eight cases underwent additional operation because of postoperative complication. Three hundred and seven cases were cured,2 cases discharged voluntarily. Seven cases died. Conclusions Currently most of acute intussusception may be cured with non-operation. Operative indication should be performed strictly. Operative procedure should be chosen on the pathological changes and the status of health. The complication could be reduced by intensive perioperation care.