小儿急性肠套叠灌肠复位术后早期复发处理

Management of early relapse of pediatric acute intussusception after ene-ma reduction

目的探讨小儿急性肠套叠灌肠复位术后早期复发的原因及处理。方法回顾性分析48例急性肠套叠灌肠复位术后早期复发的临床资料,特别是灌肠时的X线资料,并提出相应处理方法。结果早期复发组与无复发组在患儿的性别、年龄、就诊时间及灌肠压力方面比较,差异无统计学意义(χ2均<3.84,P>0.05),而在1就诊时照片有无肠梗阻X线征象、2复位后起套部仍是否可见、3解除压力后起套部是否变大及4复位后小肠充气情况等比较,差异有统计学意义(χ2均>3.84,P<0.05),复发组均选择再次灌肠复位处理。结论肠套叠空气灌肠复位后早期仍需注意复发或多次复发可能,灌肠时多次反复变换体位观察,特别注意灌肠起套部变化是减少复发和保证再次灌肠成功的关键因素之一,掌握好适应证,可选择再次空气灌肠。

Objective To explore the reasons and management of early relapse of pediatric acute intussusception after enema reduction. Methods Clinical data of 48 patients with early relapse of pediatric acute intussusception after enema reduction were retrospectively collected and analyzed, especially for X-ray data during enema. Relevant management methods were proposed. Results In the comparison of gender, age, admission time and enema pressure between the early relapse group and non-relapse group of children patients, without statistically significant differences（χ2 all 0.05）. However, as for①whether X-ray sign of intestinal obstruction could be seen during diagnosis,②whether intus-suscepted parts could be clearly seen after reduction, ③whether intussuscepted parts became larger after pressure re-lief, and ④inflation of small intestine after reduction compared between the two groups, with statistically significant differences （χ2 all〉3.84,P〈0.05）. Patients in the relapse group were all given a secondary enema reduction. Conclu-sion During early stage after reduction of intussusception by air enema, possibilities of relapse or multiple relapses should still be noticed. Observations of multiple repeated changes of body position during enema and special attention to changes of intussuscepted parts are one of critical factors for reducing relapses and ensuring a success for secondary enema. A secondary air enema can be carried out when mastering the indications.