婴幼儿肠套叠消化内镜直视下复位改良方法与传统方法的临床比较

A comparison between modified and conventional reduction under direct digestive endoscopic guidance in infants with intussusception

目的探讨消化内镜直视下肠套叠复位的改良方法,提高复位成功率。方法小儿急性肠套叠患儿48例,在消化内镜直视下渐复位,同时观察回盲瓣是否恢复原有正常解剖结构,继续进镜至回肠末端观察,通过病变水肿小肠后可见到近端正常小肠黏膜,考虑小肠已完全复位。其中采用传统消化内镜复位方法 35例,改良消化内镜复位方法 13例。结果病人应用改良内镜直视下注入空气位后,复位时间较传统方法明显缩短,特别对于以往复位不成功病例,如套叠长度长或多层套叠病人尤为明显,成功率明显提高。结论内镜直视下充气复位小儿肠套叠是一种效果确切的诊断及治疗方法,应用改良方法后复位的时间明显缩短,对以往复位不成功病例,成功率明显提高。

Objective To explore the modified procedure of reduction under digestive endoscope guid- ance for intussusception, and to further increase the success rate of reduction. Methods 48 children with acute intussusception were redueted under indrect digestive endoscope guidance. Observation was performed to confirm whether the ileoeecal valve returned to normal anatomic structure during the operation. And the endo- scope continued to be placed into the terminal ileum. When the normal mueosa of proximal intestine was seen after the endoscopy went through intestinal edema lesions, the small intestine was considered as complete re- duction. The conventional reduction under endoscope was performed for 35 patients and the modified reduction under endoscopy or the rest. Results Compared to the conventional approach, the reduction time of the mod- ified air reduction under endoscope was significantly shorter. And the success rate of the modified approach was increased markedly, especially in the eases failed to reduction previously, such as intussusception with longer segment or multiple intussusception. Conclusions Air reduction under indirect endoscope guidance is an effective approach for diagnosis and treatment in pediatric intussusception. The reduction time of the modi- fied approach is significantly shorter. And the success rate increases markedly in the cases failed to reduction previously.