成人肠套叠临床诊疗经验总结

Clinical experience of diagnosis and treatment of adult intussusception

目的通过分析成人肠套叠的临床特点,探讨该病的诊断与处理,提高诊疗水平。方法回顾性分析我科收治的成人肠套叠患者28例的临床表现、病因、处理措施及预后。结果所有患者均有腹痛,伴有呕吐10例,停止排气排便15例,果酱样大便1例,症状持续时间平均(7.50±6.54)d,腹部扪及包块13例,腹肌紧张6例,腹膜刺激征3例。CT、超声及腹部立位平片分别有15例(53.57%)、17例(73.91%)和0例提示肠套叠诊断。术前明确肠套叠19例,行肠切除25例,均行一期肠吻合术。结论根据临床表现,结合典型的超声及CT征象多可以在术前确诊肠套叠。成人肠套叠一旦确诊,应急诊行剖腹探查,多数患者需要行病变肠管的整块切除。

Objective To analyze the clinical characteristics of adult intussusception,investigate the diagnosis and treatment measures in order to improve the level of diagnosis and treatment of the disease. Methods The manifestations,etiology,treatment measures and prognosis of 28 patients with adult intussusception were reviewed retrospectively. Results Abdominal pain was observed in all the patients.The presentation symptom was nausea in 10 patients,failure to flatus and defecation in 15 patients,currant jelly stool in 1 patient,abdominal mass in 13 patients,abdominal muscle tension in 6 patients,and peritoneal irritation sign in 3 patients.The mean duration of symptoms was（7.50±6.54） days. 15 patients（53.57%） who underwent computerized tomography,17 patients（73.91%） who underwent ultrasonography examination and No patients who underwent plain abdominal X-ray suggested intussusception.Diagnosis of intussusception was confirmed before operations in 19 patients.25 cases underwent intestinal resection and onestage anastomosis. Conclusion According to the clinical manifestations and typical signs of ultrasonography and computerized tomography examination,most patients with intussusception may be confirmed. Adult intussusception patients should undergo an emergency laparotomy.The recommended surgical method is En bloc resection of the intussuscepted segment in most cases.