摘要
目的总结水压灌肠复位失败小儿肠套叠的临床特点,并进行诊治分析。方法选取2017年7月至2020年6月福建医科大学附属漳州市医院小儿外科收治的水压灌肠复位失败并行外科手术的42例小儿肠套叠患儿作为研究对象进行回顾性分析。结合水压灌肠结果和手术探查结果,分析患儿的临床特点和手术治疗情况。结果42例患儿均出现阵发性哭闹或腹痛,呕吐38例,排果酱样血便25例,脱水22例,休克9例,肠坏死6例。按套入层次分组,简单套叠22例,肠坏死1例,复杂套叠20例,肠坏死5例,复杂套叠中肠坏死比例较高。简单套叠和复杂套叠患儿的发病时间、肠坏死发生率比较,差异无统计学意义(P>0.05)。术中探查有14例患儿存在明确的病理性诱发点,占手术患儿总数的33.3%,梅克尔憩室5例,幼年性息肉2例,异位胰腺组织3例,淋巴组织增生2例,回肠重复畸形1例,Peutz-Jeghers综合征1例。按年龄分为≤2岁组和>2岁组,其中≤2岁组27例,含病理性诱发点7例,>2岁组15例,含病理性诱发点7例。≤2岁组和>2岁组患儿的病理性诱发点发生率比较,差异无统计学意义(P>0.05)。结论水压灌肠复位失败的肠套叠患儿,常继发脱水、肠坏死、中毒性休克等并发症;复杂套叠容易继发肠坏死,当水压灌肠复位困难时,应采取更加积极的手术方案;病理性诱发点在外科手术的小儿肠套叠中发生率较高,手术时应重点探查。
Objective To summarize the clinical characteristics of intussusception in children with reduction failure by hydrostatic enema and analyze its diagnosis and treatment.Methods A retrospective analysis was conducted on 42 children with intussusction who were admitted to the Department of Pediatric Surgery of Zhangzhou Hospital Affiliated to Fujian Medical University from July 2017 to June 2020.Combined with the results of water pressure enema and surgical exploration,the clinical characteristics and surgical treatment of the children were analyzed.Results All the 42 cases had paroxysmal crying or abdominal pain,38 cases vomiting,25 cases bleeding stool like jam,22 cases dehydration,9 cases shock,6 cases intestinal necrosis.There were 22 cases of simple intussusception,1 case of intestinal necrosis,20 cases of complex intussusception,and 5 cases of intestinal necrosis.The proportion of intestinal necrosis in complex intussusception was higher.There were no significant differences in the onset time and incidence of intestinal necrosis between simple and complex intussusception(P>0.05).During intraoperative exploration,there were 14 cases with definite pathological induction points,accounting for 33.3%of the total number of children,5 cases of Meckel's diverticulum,2 cases of juvenile polyps,3 cases of ectopic pancreatic tissue,2 cases of lymphatic hyperplasia,1 case of ileal duplication,and 1 case of Peutz-Jeghers syndrome.They were divided into two groups by age:≤2 years old group and>2 years old group,there were 27 cases in the≤2 years old group,with 7 cases of pathological induction points,and there were 15 cases in the>2 years old group,with 7 cases of pathological induction points.There was no significant difference in the incidence of pathological trigger points between the≤2 years old group and the>2 years old group(P>0.05).Conclusion Children with intussusception who fail to reduce by hydraulic enema are often accompanied by complications such as dehydration,intestinal necrosis and toxic shock.Complex i
作者
陈锦荣
陈文有
简紫微
叶风光
陈素华
CHEN Jinrong;CHEN Wenyou;JIAN Ziwei;YE Fengguang;CHEN Suhua(Department of Pediatric Surgery,Zhangzhou Hospital Affiliated to Fujian Medical University,Fujian Province,Zhangzhou 363000,China;Operating Room,909 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army,Fujian Province,Zhangzhou 363000,China)
出处
《中国当代医药》
CAS
2022年第35期104-108,共5页
China Modern Medicine
基金
福建医科大学启航基金项目(2021QH1263)。
关键词
小儿肠套叠
水压灌肠
外科手术
病理性诱发点
Intussusception in children
Hydrostatic enema
Surgery
Pathologic lead points
