小儿肠套叠气压灌肠未整复病例临床及影像分析

Analysis of the clinical and X-ray features of the enema unreduced intussusception in children

目的提高对气压灌肠未能整复的小儿肠套叠的临床及X线表现的认识,减少并发症发生。方法搜集1995～2005年十年间经空气灌肠证实肠套叠的患儿病例766例,其中697例经气压灌肠整复成功,69例未整复成功改手术治疗。回顾对照分析两组病例的临床、X线表现及手术所见。结果灌肠无法复位或有肠坏死病例的主要表现为①发病时间超过24小时。②血便出现早、次数或量多、腹胀明显。③套叠头部大且有分叶,位于结肠脾曲以远气压下动度差。结论气压灌肠是小儿肠套叠首选诊断及治疗方法,当遇复杂难复位病例时,综合分析临床及X线表现,评估肠套叠气压。灌肠复位可解性,并合理把握手术时机。

Objective To improve the knowledge about the difficulty of reduction by air enema or the risk of perforation. Uethod Over the past 10 years, there were 766 cases of intussusception confirmed by air pressure enema. Among these, 697 cases were successfully reduced by air enema. 69 unreduced cases were cured by operation. The main features of clinical, radiologic and operative were reviewed retrospectively. Results The most significant features of intussusception complicated with necrotic bowel or enema unreduced intussusception were ①symptoms appeared more than 24 hours.②Blood stool appeared early, more frequent and massive of more windy.③A big leaf-shaped invaginated head with weak motility on pressure. Conclusion Air pressure enema is the best methods in diagnose and treat intussusception, complex intussuscepton are difficult to reduce and those patients ought to be operation on time.