26例儿童术后肠套叠的临床研究

Clinical research on 26 cases with postoperative intussuception in children

目的探讨儿童术后肠套叠的特点诊断、治疗。方法回顾性分析我科在1999年1月～2009年12月期26例术后肠套叠和1416例原发性肠套叠的临床资料。结果本组病人住院术后肠套叠好发于6个月～3岁患儿;88%发生于术后14d内,其中92%为小肠套叠;其手术前诊断率为61%,误诊率为38%。术后肠套叠的临床表现以腹痛、呕吐、腹胀、肛门停止排气和排便为主,血便和腹部包块发生率较原发性肠套叠低(P<0.01)。26例均接受手术治疗,22例行肠套叠徒手整复术,4例行肠切除吻合术,患儿全部痊愈出院,无1例复发。结论儿童术后肠套叠常发生于腹膜后手术及肠管暴露时间长的手术后,临床症状不典型,其术前误诊率高,确诊后需手术治疗,早期诊断和手术可以减少肠坏死切除的机会。

Objective To evaluate the and clinical feature diagnosis and treatment of postoperative intussusception in children. Methods Twenty six cases with postoperative intussusception and 1416 cases with primary intussuception in children were analysed retrospectively. Results Most cases occurred within 14 days after children accepted the first operation, 92% of all cases were enteric intussusception.The common clinical symptoms were abdominal pain, bilious vomiting, abdominal distension.Bloody stool and abdominal mass were not common.All children had to accept the second operation,only 16 cases were diagnosed before operation.All patients were cured, and there was no case of recurrence. Conclusion Enteric intussusception is the most common type in postoperative intussusception in children. The clinical symptoms of postoperative intussusception are atypical and it is extremely difficult to identify during the early postoperative course. Early diagnosis and operation are essential to reduce the risk of enterectomy in postoperative intussusception.