肠套叠手术中对回盲部“风帆样”系膜的认识及处理

目的探讨回盲部"风帆样"系膜与肠套叠发病的关系及手术切除的意义。方法回顾性分析2008年1月—2013年12月收治的小儿肠套叠手术复位96例的临床资料。结果本组96例中继发性肠套叠2例,术后肠套叠1例,均未探及回盲部"风帆样"系膜。原发性肠套叠93例,探及回盲部"风帆样"系膜58例,占肠套叠手术病例的60.4%(58/96),其中肠套叠解剖分型为回结型77例,探及"风帆样"系膜54例;回回结型12例,探及"风帆样"系膜4例;回回型3例,结结型1例,均未探及"风帆样"系膜。均行肠套叠手术复位及"风帆样"系膜切除术,术后随访3个月~2年,均无肠套叠复发。结论回盲部"风帆样"系膜为术中清晰可见的解剖异常结构,在原发性肠套叠病例中出现频率高,与肠套叠发病存在相关性,手术切除回盲部"风帆样"系膜,可预防肠套叠复发。     

急性肠套叠灌肠复位术后患儿早期复发的影响因素分析

目的分析急性肠套叠灌肠复位术后患儿早期复发的影响因素。方法选取医院2017年10月—2020年10月急性肠套叠行复位术患儿240例,经超声检查,32例复发,设为复发组,未复发患儿208例设为对照组,比较两组患儿临床资料,采用多因素Logistic回归分析急性肠套叠灌肠复位术后患儿早期复发独立危险因素。结果单因素及多因素Logistic回归分析显示,继发腹泻、进食过早、回盲部水肿是急性肠套叠灌肠复位术后患儿早期复发的独立危险因素(P<0.05)。结论针对继发腹泻、进食过早、回盲部水肿患儿早期复发的独立危险因素,应尽早加强防范,降低急性肠套叠灌肠复位术后患儿早期复发率。     

腹腔镜手术下不同固定方法治疗小儿回结型肠套叠的临床效果比较

目的 分析腹腔镜下回盲部-侧腹膜固定术与腹腔镜回肠-升结肠固定术治疗小儿回结型肠套叠的临床效果。方法 收集2015年5月至2023年2月达州市中心医院收治的小儿回结型肠套叠117例,根据术中不同的固定方式分为回盲部-侧腹膜固定组(A组)62例及回肠-升结肠固定组(B组)55例,对比分析两组患儿的围术期指标、手术前后血清C反应蛋白水平、术后并发症发生率、随访效果、患儿家属满意度、住院费用及远期并发症。结果 A组手术耗时、术后进食等待时间、住院天数、术后至肛门排气时间均短于B组,术后下床活动时间早于B组(P<0.05);两组治疗后血清CRP水平均升高,B组CRP水平高于A组(P<0.05); A组切口感染、切口疝及迟发性肠穿孔、坏死、粘连、复发等并发症发生率低于B组(P<0.05);两组患儿家属满意度及住院费用比较,差异无统计学意义(P>0.05)。结论 腹腔镜回盲部-侧腹膜固定术与回肠-升结肠固定术治疗小儿回结型肠套叠均可能够获得良好效果,而回盲部-侧腹膜固定方法手术耗时、术后进食等待时间、平均住院天数、术后至肛门排气时间缩短,术后下床活动时间提前,术后并发症发生...     

超声在小儿假性肠套叠中的诊断价值

目的探讨在小儿肠套叠水压灌肠复位后,超声对假性肠套叠的诊断价值。方法 293例肠套叠患儿在超声监视下,行水压灌肠治疗后观察是否出现假性肠套叠,总结其声像图特征及临床价值。结果水压灌肠后,15例患儿出现假性肠套叠,其中9例小肠性和4例回盲瓣炎性假性肠套叠,2例同时存在两种套叠。小肠性套叠在24h内可自行复位,回盲瓣炎性套叠经抗炎对症治疗后恢复。假性肠套叠的包块套入长度、"同心圆"直径均明显小于复发性肠套叠(3.71±0.84VS 5.36±1.25,2.13±0.52VS 3.25±0.71,P均0.05)。结论小儿肠套叠灌肠复位后,可出现小肠性和回盲瓣炎性假性肠套叠,高频超声可有效识别假性肠套叠,降低短时间再次水压灌肠或手术治疗的风险。     

小儿复发性肠套叠29例分析

目的 总结小儿复发性肠套叠临床特点,探讨其病因及治疗.方法 回顾分析2001年～2006年5年间复发性肠套叠29例,对其复发次数、复发年龄、复发时间间隔、复发临床表现及治疗方法 等作总结.结果 29例患儿共复发43次;复发年龄3月～5岁,小于2岁占63%;复发时间间隔2周～36月,2周内复发占44%;临床症状与初发类似,血便占23%;空气灌肠复位34例次,手术复位9例次,发现1例美克尔憩室.结论 小儿复发性肠套叠可能与病毒感染有关,2周内复发率较高.治疗上空气灌肠为首选,不能复位者手术,疑有器质性病变者可手术探查.     

腹腔镜下整复28例难复性肠套叠临床疗效分析

【目的】探讨腹腔镜手术在难治性小儿肠套叠治疗中的应用。【方法】28例接受腹腔镜治疗小儿肠套叠,气管插管全麻,建立人工气腹,置入腹腔镜探查病变情况并采取相应的手术方式。【结果】28例中2例因肠套叠反复发作行腹腔镜手术探查治疗,探及回盲部游离为反复肠套叠的原因,并行回结肠固定。25例患儿因空气灌肠失败行腹腔镜手术治疗,结果20例腹腔镜下直接用无损伤钳操作复位成功;3例肠套叠已自行复位,其中1例合并有美克尔憩室;1例腹腔镜下直接用无损伤钳操作复位失败,术中加用空气灌肠辅助成功;1例中转开腹。3例起病超过48h无空气灌肠指征,在腹腔镜下直接用无损伤钳操作复位成功。【结论】腹腔镜手术治疗空气灌肠整复失败的小儿肠套叠是一种安全有效的微创疗法,并可使假阳性患儿避免开腹手术,及时发现多发性肠套叠及发现其它先天性肠管畸形;对频繁发作的肠套叠病因及治疗亦有帮助。     

空气灌肠复位失败肠套叠X线诊断与手术对照分析

目的:探讨空气灌肠复位失败肠套叠X线诊断的影像学表现,为指导临床治疗提供参考。方法:以2017年1月-2018年1月我院收治82例小儿肠套叠患者为研究对象,全部患儿均于X线引导下进行空气灌肠,复位失败后改行手术治疗。观察患儿手术结果及复位失败肠套叠X线诊断的影像学表现。结果:82患儿经手术治疗症状均解除,手术成功率100%。肠套叠类型:回-结-结型47例,回-回-结型21例,回-结型6例,回-回型5例,回-回-结-结型3例,其中复杂型肠套叠构成比最高,占86.59%。X线下观察可见复位失败肠套叠套头呈不规则形状,套头较长,空气加压灌注时,套头推进缓慢,在各肠断有停顿,或不推进,停滞在回盲部,套头随灌注气压大小而呈弹簧状收缩,但多次加压灌注套头均不消失。结论:空气灌肠复位失败肠套叠X线表现具有一定特征性,对于复位失败的患者,临床应早期改行手术,以减少并发症,保证治疗安全。     

解痉药物及糖皮质激素在小儿肠套叠复位成功后预防复发的研究

目的探讨解痉药物及糖皮质激素在小儿肠套叠复位成功后预防短期复发作用。方法收集2014年1月至2018年4月在我院住院的回盲套型的肠套叠患儿450例,均在空气灌肠复位并成功。根据不同用药分为三组,每组各150例:A组空气灌肠前后均不使用; B组空气灌肠前后使用山莨菪碱(0. 2 mg/kg)及阿托品(0. 02 mg/kg),C组空气灌肠前后使用山莨菪碱(0. 2 mg/kg)、阿托品(0. 02 mg/kg)及地塞米松(0. 3 mg/kg),比较三组患儿的进食时间、住院天数、住院费用复发情况。结果三组平均进食时间、住院天数、住院费用、复发率比较差异有统计学意义(均P 0. 05),其中B组平均进食时间、住院天数较A组缩短,住院费用、复发率发生较A组低; C组平均进食时间、住院天数均较A、B组缩短,C组住院费用、复发率发生均较A、B组低。结论解痉药物可促进肠套叠胃肠道功能恢复,糖皮质激素可抑制炎症反应及促进炎症水肿消退,二者联合应用于在肠套叠空气灌肠复位后可有效缩短进食时间、减少复发率,从而缩短住院时间及降低住院费用。     

空气灌肠整复小儿肠套叠影响因素的临床分析

目的 探讨小儿肠套叠空气灌肠复位的影响因素。方法 169例小儿肠套叠，观察患儿全身情况、肠套叠类型、发病年龄、发病时间对空气灌肠复位成功率的影响。结果 对1岁以下、发病24h以内、全身情况较好、回盲型、回结型肠套叠患儿，空气灌肠复位成功率高，与对照组比较差异有显著性（P〈0．05）。结论 对1岁以下、发病24h以内、全身情况较好、加盲型、回结型肠套叠患儿可采用空气灌肠复位，且成功率高。     

小儿肠套叠空气灌肠复位失败的影像学分析

目的提高对空气灌肠复位治疗小儿肠套叠的认识。方法回顾性分析28例空气灌肠治疗小儿肠套叠复位失败的影像学特点,探讨影响复位成功因素。结果小儿肠套叠空气灌肠复位失败的套叠类型为回结型(13例)、回回结型(10例)、回回型(1例)、回回结结型(2例)、回结结型(1例)及回盲结型(1例),后3种类型在复位成功病例中较少见。结论透视下空气灌肠是诊断与治疗小儿肠套叠的最好方法;对于复位失败的病例应及时手术治疗,不应强行复位,避免并发症的出现。     

Point-of-care ultrasound diagnosis of small bowel-small bowel vs ileocolic intussusception

BackgroundIdentification of intussusception is feasible with emergency department (ED) point-of-care ultrasound (PoCUS) due to its ease-of-use and high accuracy. Little is known about the clinical characteristics and outcomes of small bowel-small bowel intussusception (SB-SBI) relative to ileocolic intussusception (ICI) identified by PoCUS.MethodsWe conducted a retrospective cohort study at a single, tertiary care, urban pediatric ED of intussusception identified by PoCUS. Demographic information, clinical data, and outcomes, including clinical course, intussusception characteristics, recurrence rates, and interobserver agreement (Cohen's kappa), were evaluated.ResultsED PoCUS identified thirty-seven patients with intussusception over a 4-year period. Twenty-one patients (57%) identified were SB-SBI. The median age was 54 months (IQR 35–76 months) for SB-SBI and 8 months (IQR 5.8–13.5 months) for ICI. The mean diameter was 1.68 cm (SD 0.52 cm) for SB-SBI and 2.74 cm (SD 0.43 cm) for ICI (p < 0.05). Two of 21 (9.5%) SB-SBI subjects required surgical intervention, while the rest spontaneously reduced. Fourteen of 16 (88%) ICI subjects required intervention. There were two (9.5%) recurrences of SB-SBI and 1 (6.3%) recurrence of ICI confirmed on PoCUS. Cohen's kappa was 0.85 (95% CI 0.68–1.0).ConclusionsSB-SBI may be identified more frequently than previously thought when screened with ED PoCUS. Older children with SB-SBI may have underlying lead-points and may require surgical intervention. PoCUS can help differentiate between variants of intussusception that range from a surgical emergency to a transient source of abdominal pain that may be recurrent and otherwise unexplained, allowing clinicians to better manage these patients accordingly.     

Effectiveness of pneumatic reduction of ileocolic intussusception in children

A total of 158 consecutive therapeutic air enemas were performed upon 133 patients during a 2-year period. Perforation and/or an impairment of the general condition of the children were the only main contraindications for the reduction attempt (five patients). Successful reductions were achieved in 89% of cases with no complications. Operation was performed in all 17 cases of unsuccessful reduction: resection in four cases, easy manual reduction in nine, difficult manual reduction in two, and spontaneous reduction in two. There were 16 (12%) patients with one or more recurrent episodes. In 23 (16%) cases, following pneumatic reduction, a swollen ileocecal valve showing a multiple appearance was observed. This fact sometimes results in a differential diagnosis with incomplete reduction; in all these cases, small bowel aeration was always a sign of complete reduction. No significant difference was noted between a swollen ileocecal valve and patient age, duration of symptoms, presence of small bowel obstruction, and further recurrences. Air enema has improved our previous success obtained with hydrostatic reduction (79%), as well as being a simpler, cleaner, and faster technique for intussusception reduction in children.     

Computed tomography of adult ileocolic intussusception

Computed tomographic evaluation of ileocolic intussusception in an adult is presented. Upper gastrointestinal series with orally administered water-soluble contrast agent suggested obstruction in the lower part of the small intestine, but computed tomography made a definitive diagnosis. Pathognomonic CT findings of ileocolic intussusception are presented.     

超声引导下电脑遥控灌肠整复仪水压灌肠治疗小儿肠套叠的临床研究

目的探讨超声引导下电脑遥控灌肠整复仪水压灌肠治疗小儿肠套叠的临床疗效。方法对185例急性肠套叠患儿行电脑遥控灌肠整复仪水压灌肠（压力7～9kPa）。结果肠套叠整复成功171例,未成功14例,整复成功率92．4％,复位时间10～40min,灌肠过程中未发现肠穿孔及患儿呕吐,出院后短期随访无复发。结论电脑遥控灌肠整复仪水压灌肠治疗小儿肠套叠效果好,且安全性好。     

颈椎后纵韧带骨化症的手术治疗并发症探讨

目的探讨颈椎后纵韧带骨化症的三种手术方式的疗效以及并发症。方法选择确诊为颈椎后纵韧带骨化症并进行手术治疗的患者168例,随进分为A组(颈后路手术组)、B组(颈前路手术组)、C组(前后路联合手术组)进行临床研究。研究三组疗效以及并发症发生情况。结果 A组手术后颈椎神经功能评分及改善率显著高于B组和C组,差异有显著性(P0.05)。A组患者的总体并发症为15.0%,显著低于B组(18.3%)和C组(45.0%),差异有显著性(P0.05)。结论三种手术方式在治疗颈椎后纵韧带骨化症的过程中均不可避免出现一些并发症,但是其中以颈后路手术的临床疗效较好,并发症较少。     

不同术式治疗翼状胬肉的疗效观察

[目的]通过对比分析2007～2010年间在本院接受不同手术方式治疗翼状胬肉的疗效结果,为选择更理想的治疗翼状胬肉的手术方式提供参考依据.[方法]病例总计141眼,分别采用A组单纯胬肉切除加巩膜暴露术（40眼）,B组单纯胬肉切除加自体结膜瓣移植术（30眼）,C组单纯胬肉切除加丝裂霉素C的辅助疗法（34眼）,D组单纯胬肉切除加羊膜移植术（37眼） 四种显微手术方式进行治疗,术后随访48个月,比较各组的术后复发率及并发症.[结果]A组复发率为20%,B组术后无一例复发,C组的复发率为5.8%,D组的复发率为13.5%,四组间复发率差异有统计学意义（χ2=12.125,P〈0.05）,四组患者均有部分病例发生了周边角膜云翳.[结论]翼状胬肉切除加自体结膜瓣移植术或联合丝裂霉素C辅助疗法是治疗翼状胬肉相对安全有效的手术方式     

保留伸肘装置方式手术治疗儿童Gartland Ⅲ型肱骨髁上骨折的疗效分析

[目的]探讨采用保留伸肘装置的手术方式治疗儿童GartlandⅢ型肱骨髁上骨折的疗效。[方法]2000年10月至2007年4月,对56例平均年龄7．5岁的儿童GartlandⅢ型肱骨髁上骨折患儿采用保留伸肘装置的手术方式治疗。患儿均无伴发血管、神经损伤和筋膜室间隔综合征。[结果]术后56例获得随访,随访时间为6～15个月,平均11．5个月。所有骨折均获得愈合。根据Flynn标准进行疗效评价,其中优22例（39．3％）,良21例（37．5％）,可9例（16．1％）,差4例（7．1％）。伤后8h内手术的优良率为88．1（37／42）％,伤后8h后手术的优良率为64．3％（9／14）。直接手术治疗的优良率为89．5％（34／38）,曾接受手法复位的优良率为66．7％（8／12）。[结论]采用保留伸肘装置的手术方式治疗儿童Gartland Ⅲ型肱骨髁上骨折可取得满意的疗效,是安全、有效的治疗方法。     

Colorectal intussusception secondary to sigmoid carcinoma in an adult

Although intussusception is relatively common in children, it is clinically rare in adults A 54-year-old woman who presented with cramping abdominal pain and rectal bleeding was found to have sigmoid rectal intussusception secondary to adenomatous polyps of the sigmoid colon. Following confirmation of intussusception by CT scan, surgical resection was performed after manual reduction.     

Adult ileocolic intussusception secondary to a submucosal cecal lipoma

Intussusception is a relatively common cause of intestinal obstruction in children but a rare clinical entity in adults, representing fewer than 1% of intestinal obstructions in this patient population. We present a rare case of a 44-year-old female patient with intestinal obstruction due to ileocolic and colocolonic intussusception secondary to an intramural cecal lipoma. Diagnosis was made by barium enema and abdominal computed tomography and was confirmed by colonoscopy. After failure of conservative treatment, the patient underwent surgery.