结肠镜下早期结肠套叠和结肠扭转复位的诊治体会

Experience of diagnosis and treatment of early colonic intussusceptions and colonic volvulus diaplasis under colonscopy

目的探讨在早期结肠套叠和结肠扭转疾病中结肠镜下复位成功的诊治体会。方法回顾性分析北京军区总医院消化内科近10年来应用结肠镜对19例早期结肠套叠、结肠扭转的治疗资料和经验,总结诊治体会。结果 17例患者均在结肠镜下成功复位,复位成功率89.47%(17/19)。2例横结肠扭转患者复位失败,转入外科手术。5例回-结肠套叠患者中4例患者无明确病因,1例阑尾术后2周出现回-结肠套叠并复位成功;14例肠扭转中1例女性患者24 h时行钡灌肠治疗,4 h后症状加重,在结肠镜检查下复位成功,恢复良好,11例患者在24 h内行结肠镜检查并成功复位。结论早期的结肠套叠、结肠扭转,应用结肠镜下注入30℃温蒸馏水和反复旋转、钩拉旋转镜身进行复位,是一种安全有效的便捷方法。

Objective To explore the efficacy of colonoscopic reduction on early colonic volvulus and colonic intussusception. Methods The clinical data of 19 cases of early colonic intussusception and colonic volvulus from Department of Gastroenterology, the Military General Hospital of Beijing PLA in recent 10 years who received colonoscopy dia- plasis treatment were summarized and analyzed. Results Seventeen patients were successfully reset under colonoscopy; the success reset rate was 89.47% （17/19）. Two cases of transverse torsion were reset failed and then transferred to surgical operation. In 5 cases of ileocolic intussusception, 4 patients had no clear cause and 1 patient who suffered intus- susception 2 weeks after appendectomy was successfully reset under colonoscopy. Among the 14 cases of volvulus, 1 fe- male patient received an unsuccessful treatment by barium enema at 24 hours, and the symptom was aggravated 4 hours later, and then she was successfully reset under colonoscopy; 11 cases were successfully reseted under colonoscopy in 24 hours. Conclusion For early colonic intussusception and volvulus of sigmoid colon, colonoscopy reset is a convenient safe and effective method by through inject 30 ℃ temperature distilled water and repeat rotation, hook rotating mirror.