婴幼儿肠套叠合并阑尾炎X线表现的病理基础及临床意义

Intussusception Combined with Appendicitis in Infants: X-ray Findings and Pathological Basis

目的 探讨婴幼儿肠套叠合并阑尾炎的X线表现及其临床意义。资料与方法 对28例经手术病理证实的婴幼儿肠套叠合并阑尾炎的X线表现及临床资料进行回顾性分析。结果 (1)17例回-结型肠套叠中合并急性单纯性阑尾炎13例,化脓性阑尾炎2例;11例复合型肠套叠中合并急性阑尾炎4例,化脓性阑尾炎6例。发现3例合并慢性阑尾炎,炎症为继发再次肠套叠的诱因。(2)主要X线表现:①腹部少气或无气征15例;②右侧腹膜外脂线局部或全部模糊征18例;③右下腹肠腔异常积气和/或小肠梗阻征9例。右侧腹膜外脂线局部或全部模糊征象出现率最高。结论 阑尾炎是婴幼儿肠套叠的最主要早期并发症。X线表现结合临床资料对其发生有重要提示意义,对预防阑尾炎症致继发肠套叠或其他并发症有重要价值,尤其在空气灌肠整复后的治疗上。

Objective To discuss the X-ray findings and their clinical significance of intussusception with appendicitis in infants. Materials and Methods X-ray findings and clinical data of 28 infants with pathologically-proved intussusception combined with appendicitis were retrospectively analyzed. Results (1) Of 17 cases with simple ileocolic intussusception, acute simple appendicitis was accompanied in 13 and acute suppurative appendicitis in 2, while of 11 cases with complex intussusception, acute simple appendicitis and acute suppurative appendicitis were accompanied in 4 and 6, respectively. Chronic appendicitis was accompanied in 3 cases, which induced the recurrence of intussusception. (2) The main X-ray findings were as follows. ① Decreased amount of abdominal gas or gasless abdomen ( n = 15). ②Partial or total blurred right flank stripe ( n = 18). ③ Abnormal intestinal gas shadow at the right lower abdomen and/or signs of small intestinal obstruction ( n = 9) . Conclusion Appendicitis is the most commonly seen complication at the early stage of intussusception in infants. X-ray signs as well as the clinical data are very valuable in suggesting the presence of appendicitis and in guiding the clinical management.