地级市三级综合医院小儿肠套叠诊治经验探讨

Experience in the diagnosis and treatment of pediatric intussusception in a tertiary general hospital in prefecture city

目的分析小儿肠套叠的病例资料,总结两次空气灌肠法联合腹腔镜手术在小儿肠套叠治疗中的应用价值,介绍地级市三级综合医院小儿肠套叠诊治经验。方法回顾性分析孝感市中心医院普通外科(小儿外科专业组)自2020年6月至2023年6月小儿肠套叠237例的病例资料,总结其治疗过程及结局。结果237例患儿年龄6个月至10岁,诊断明确后,首先采用X线监视下空气灌肠复位,经过1次空气灌肠复位成功195例(82.3%)。第1次空气灌肠失败后,除1例因腹胀严重、精神差行开腹手术外,其余41例均经过第2次空气灌肠,复位成功28例,总灌肠成功率94.1%。二次灌肠失败后的13例患儿行腹腔镜手术,其中腹腔镜下成功复位8例,术中中转开腹5例(2例行手法复位术,3例行肠切除肠吻合术)。所有患儿均顺利恢复出院。治疗后随访3个月至3年,行空气灌肠复位成功的患儿,出现复发8例,复发率3.6%,均行再次空气灌肠复位成功,行手术治疗病例随访无异常。结论采用两次空气灌肠法联合腹腔镜手术的方法,取得了很好的效果,灌肠成功率明显提高;空气灌肠复位不成功的患儿,若无高度腹胀,能耐受气腹,首选腹腔镜手术,患儿创伤小、恢复快,值得地级市三级综合医院临床推广。

Objective To analyze the data of pediatric intussusception,summarize the application value of twice air enema combined with laparoscopic surgery in the treatment of pediatric intussusception,and introduce the experience in the diagnosis and treatment of pediatric intussusception in a tertiary general hospital in prefecture city.Methods The clinical data of 237 cases of pediatric intussusception in the General Surgery Department(Pediatric Surgery Professional Group)of Xiaogan Central Hospital from June 2020 to June 2023 were retrospectively analyzed,and the treatment process and outcomes were summarized.Results The 237 children were aged 6 months to 10 years.After the diagnosis was confirmed,air enema reduction was first performed under X-ray monitoring.After one-time air enema,195 cases(82.3%)were successfully reducted.After the failure of the first time air enema,except for one case who underwent open surgery due to severe abdominal distension and poor mental state,the remaining 41 cases underwent the second time air enema,and 28 cases were successfully reducted,with a total enema success rate of 94.1%.The 13 children who failed in the two times of enema underwent laparoscopic surgery,and 8 of them were successfully reducted under laparoscope and 5 were converted to open surgery(2 underwent manual reduction and 3 underwent intestinal resection and anastomosis).All patients recovered well and were discharged.All cases were followed up for 3 months to 3 years.Among the children who underwent successful air enema reduction,8 cases experienced recurrence,with a recurrence rate of 3.6%.All recurrent cases underwent air enema reduction successfully again,and there were no abnormalities in the follow-up of patients who underwent surgical treatment.Conclusion The method of twice air enema combined with laparoscopic surgery has achieved good results and the success rate of enema is significantly improved.For children with unsuccessful air enema reduction who do not have high abdominal distension and can tolerate pneumoperitoneum laparoscopic surgery is the first choice.The patient has minimal trauma and fast recovery,so the method is worthy of clinical promotion in tertiary general hospitals in prefecture cities.