新生儿原发性肠套叠临床诊治特点浅析

Clinical features and treatment of the idiopathic intussusception in neonates

目的探讨新生儿原发性肠套叠的临床表现及诊断治疗特点。方法对5例新生儿原发性肠套叠的诊治经过进行回顾性分析,探讨新生儿原发性肠套叠的诊治特点。结果5例患儿中,2例有窒息或宫内窘迫病史;5例表现为呕吐,便血3例,腹胀3例,腹壁水肿2例,包块1例;5例作X线平片检查,2例完全梗阻,3例不全梗阻;4例超声检查显示:包块3例,典型的同心圆、套筒表现1例;水压灌肠复位1例失败,全部接受手术治疗,证实为原发性肠套叠,其中小肠套叠2例,回盲型2例,回结型1例;手法复位1例,肠切除吻合4例;死亡1例。结论新生儿肠套叠可以是原发性的。临床表现不典型,可表现为新生儿肠梗阻,术前明确诊断较困难;小肠套叠相对多见;早期超声检查具有诊断意义;早期手术治疗效果满意。

Objective To explore the clinical features and treatment of the idiopathic intussusception in neonates. Methods Five neonates with idiopathic intussusception underwent operations in this institute between 1995 and 2004. The clinical data including clinical presentations, B ultrasound examination, and treatment were retrospectively analyzed in these patients. Results Out of 5 neonates, 2 cases had the history of asphyxia or intrauterine distress. Vomiting was found in all cases, blood stool in 3, abdominal dilatation in 3, abdominal edema in 2, and abdominal mass in 1. The mass in the abdominal cavity was found in 3 patients through B ultrasound examination. One neonate underwent US-guided saline hydrostatic reduction but failed. And all patients underwent surgical correction and the final diagnosis was made. The manual reduction was performed on one case and the enteric resection was performed on the other 4 cases. Only one neonate died of multiple organic failures after operation. Conclusions It is difficulty to make the diagnosis of the idiopathic intussusception in neonates before operation because there are no specific presentations in these neonates. Surgical correction for the idiopathic intussusception in neonates can get the satisfactory results.