小儿坏死性肠套叠外科治疗93例分析

The surgical treatment of necrotic intussusception in children (a review of 93 cases)

目的 :探讨小儿坏死性肠套叠的病因、诊断、低压空气灌肠复位的作用、手术治疗及并发症的防治。方法 :对经手术治疗的 93例小儿坏死性肠套叠进行回顾性分析。结果 :79例原发性肠套叠 ,14例继发性肠套叠。套叠类型为回 结肠型 73例 ,小肠型 15例 ,结 结肠型 5例。全组均行套叠复位加坏死肠段切除一期吻合术。术前误诊 5例 ,死亡 3例。结论 :①局部解剖因素是小儿肠套叠发生的主要原因 ;②B超检查有助于肠套叠的诊断 ;③对于复发性肠套叠不宜反复多次地进行低压空气灌肠复位 ;④手术原则是对于高度怀疑肠管坏死的不能姑息 ,应积极切除 ,但同时亦应尽可能多地保留有活力的肠管及回盲瓣。

Objective:To study the pathogeny,diagnosis,role of air enema with low pressure,operational treatment and prevention of complications of necrotic intussusception in children Methods: 93 cases of pediatric necrotic intussusception treated with surgical operation were analyzed retrospectively Results: There were 79 cases of primary intussusception and 14 cases of secondary intussusception in this study The type of intussusception:73 cases of ileocolonic intussusception,15 cases of ileal intussusception and 5 cases of colonic intussusception All cases were performed an operation of resection of necrotic intestine after reduction of intussusception 5 cases were not diagnosed correctly before operation and 3 cases died Conclusion: 1) Local anatomical factor wound be essential for the occurrence of intussusception;2)B ultrasound examination is useful for the diagnosis of intussusception;3)Reduction with low pressure air enema under X ray fluoroscopy again and again is not suitable for recurred intussusception;4)The principle of operation is resecting the highly suspected necrotic intestine positively but meanwhile reserving the vital intestine and ileocecal valve possibly