原发性肠套叠的治疗经验总结

Experience summary in the treatment of primary intussusception

目的通过对威海市中心医院1年肠套叠住院治疗资料的整理,总结原发性肠套叠治疗的经验。方法选取2018年9月1日至2019年8月31日在威海市中心医院住院的肠套叠患儿共181例,其中男93例,女88例,年龄(3.17±1.83)岁,均通过B超明确诊断,先行少量灌肠液灌肠,然后复查B超或者行空气灌肠。通过B超或空气灌肠均未发现有肠道器质性病变,175例通过非手术治疗整复,6例患儿转入妇女儿童专科医院治疗。通过分析肠套叠的大小、肠套叠整复方法与效果的关系,发现原发性肠套叠治疗的新经验。结果181例肠套叠患儿中,灌肠液灌肠后复查B超肠套叠消失76例,仍存在套叠的36例;行空气灌肠整复99例。肠套叠小包块(长径、短径、长度均≤2.0 cm)灌肠液灌肠后整复63.27%(31/49),肠套叠大包块(长径、短径或长度>2.0 cm)灌肠液灌肠后整复34.23%(38/111)。住院期间发生再套叠共19例,复套率10.50%,其中肠套叠大包块11例,这11例中2例是灌肠液灌肠即整复后发生再套叠,9例是空气灌肠整复后发生再套叠;肠套叠小包块有5例在住院期间发生再套叠,其中1例是灌肠液灌肠即整复后再套叠,4例是空气灌肠整复后发生再套叠。出院1周内肠套叠复发的有3例,1例患儿2次住院都是肠套叠大包块,均通过灌肠液灌肠即将肠套叠整复;1例患儿2次住院都是肠套叠大包块,均通过空气灌肠整复;1例患儿第1次住院是肠套叠小包块,通过灌肠液灌肠整复,第2次住院是肠套叠大包块,行空气灌肠将肠套叠整复。结论部分原发性肠套叠可自行整复,少量灌肠液灌肠即可促进部分原发性肠套叠的自行整复,通过超声检查监测,这是安全的,不增加复套率;尤其对肠套叠最大径、长度均≤2.0 cm的小包块肠套叠成功率更高。因此针对原发性肠套叠,注意监测B超,必要时给予少量灌肠液灌肠,部分患儿可以免于行空气灌肠;若仍有肠套叠,可继续行空气灌肠或B超监测下水压灌肠。

Objective To summarize the experiences in the treatment of primary intussusception through the collation of the data of hospitalized patients with intussusception in Weihai Central Hospital in 1 year.Methods A total of 181 cases of children with intussusception hospitalized in Weihai Central Hospital from September 1,2018 to August 31,2019 were selected,including 93 males and 88 females,with an age of(3.17±1.83)years old.They were clearly diagnosed by B-ultrasound,firstly,a small amount of enema solution was administered,and then B-ultrasound was repeated or air enema was performed.No organic intestinal lesions were found by B-ultrasound or air enema;175 cases were rehabilitated through non-surgical treatment,and 6 cases were transferred to women and children specialist hospitals for treatment.By analyzing the relationships between the size of intussusception,the method of intussusception rectification,and the effect,we found new experiences in the treatment of primary intussusception.Results Among the 181 cases,76 cases of intussusception disappeared by B-ultrasound after enema,and 36 cases of intussusception still existed;99 cases were rehabilitated by air enema.Thirty-one cases(63.27%)of small intussusception masses(long diameter,short diameter,and length≤2.0 cm)were restored after enema,and 38 cases(34.23%)of large intussusception masses(long diameter,short diameter,or length>2.0 cm)were restored after enema.A total of 19 cases of re-intussusception occurred during the hospitalization,with a recurrence rate of 10.50%.Among them,11 cases of re-intussusception were large intussusception masses.Of the 11 cases,2 cases were re-intussusception after enema,and 9 cases occurred after air enema.Five cases of small intussusception masses occurred during the hospitalization,of whom 1 case was re-intussusception after enema,and 4 cases occurred after air enema.There were 3 cases of re-intussusception within 1 week after discharge.Among them,1 case had large intussusception masses in both hospitalizations,and the intussusception was restored through enema;1 case had large intussusception masses in both hospitalizations,and the intussusception was restored through air enema;one child was hospitalized with small intussusception masses for the first time and was restored by enema,and was hospitalized with large intussusception masses for the second time and was treated through air enema.Conclusions Part of primary intussusception can be corrected spontaneously.Enema with a small amount of enema solution can promote the self-repair of some primary intussusception.Ultrasound monitoring shows that it is safe and does not increase the recurrence rate;especially for small masses with the maximum diameter and length of intussusception≤2.0 cm,the success rate of intussusception rectification is higher.Therefore,for primary intussusception,we should pay attention to monitoring B-ultrasound and giving a small amount of enema solution if necessary,thereby some children can avoid air enema;if there is still intussusception,air enema or water pressure enema under ultrasound monitoring can be continued.