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婴幼儿急性肠套叠空气灌肠治疗

目的　总结婴幼儿急性肠套叠X线透视下空气灌肠整复经验体会，提高整复成功率。 方法　对2011年1月－12月入院、并经空气灌肠及手术证实276例肠套叠患儿的临床资料进行回顾性分析。 结果　经空气灌肠复位成功268例，其中5例延迟再灌复位成功，6例肠套叠空气灌肠整复失败转为手术治疗，2例未经空气灌肠直接手术治疗，整复率达97.1%（268/276）。患儿全部治愈无并发症，无一死亡。 结论　X线透视下空气灌肠诊断及整复治疗婴幼儿肠套叠，操作简便，是一项较好的治疗手段，而手法得当将达到满意的治疗结果；延迟再灌复位成功率较高，值得推广应用。

Diagnosis and Treatment of Intussusception in Adults （Report of 167 Cases）

【摘要】目的探讨成人肠套叠的临床特点和诊治原则。方法对1980年1月至2004年2月期间我院收治的167例成人肠套叠临床资料进行回顾性分析。结果术前确诊79例，占47.3%。167例中159例行手术治疗，其中116例为肠道肿瘤,良性48例，恶性68例； 余51例为手术或外伤后、肠道炎症、盲肠过长等。共有117例行肿瘤根治性切除术或相应肠段切除术，50例行单纯复位或复位后固定术。2例术后死亡，余均恢复良好，134例随访2个月～10年，无肠套叠复发。结论提高对成人肠套叠的认识是诊断的关键，检查应选用B超、CT、钡灌肠等，治疗则首选手术治疗。

空气灌肠整复小儿肠套叠临床分析

【摘要】 目的 探讨空气灌肠整复小儿肠套叠的方法,提高整复成功率。方法 2007年1月—2008年12月经超声明确诊断小儿急性肠套叠患儿328例,行空气灌肠诊断(压力4～6 kPa)和整复(压力7～14 kPa),分析整复成功率与肠套叠发生时间、套头所在部位、使用解痉药物之间的关系。结果 空气灌肠整复成功306例,成功率93%,其中68例为二次整复。整复率与肠套叠发病时间、患儿全身情况及肠套叠的病理类型、整复压力的掌握及解痉药物的适时选用有关。结论 采用适当的操作方法，利用空气灌肠整复小儿肠套叠能提高成功率。

腹腔镜在肠套叠空气灌肠禁忌证患者中的应用

目的探讨腹腔镜下手法空气灌肠在治疗存在空气灌肠禁忌证的肠套叠患者中的应用优势。 方法回顾性分析笔者所在医院2009年1月至2012年12月期间收治的95例肠套叠患者的临床资料。 结果95例肠套叠患者的发病时间为48～72 h，其中40例行腹腔镜下手法空气灌肠治疗，55例行开放手术治疗，两种治疗方法在手术时间〔（56.61±13.53）min比（54.97±14.35）min〕、术中出血量〔（2.85±1.47）mL比（3.03±1.51）mL〕、术后肠功能恢复时间〔（39.61±13.43）h比（41.67±14.05）h〕、术后住院时间〔（4.85±1.27）d比（4.93±1.35）d〕、切口脂肪液化发生率（0比3.6%）和肠梗阻发生率（0比1.8%）方面比较，其差异均无统计学意义（P＞0.05）。腹腔镜组截孔瘢痕几乎不可见，脐部外观无破坏。 结论腹腔镜下手法空气灌肠治疗以往发病时间在48～72 h禁忌空气灌肠的肠套叠患者是可行的，其创伤小，并发症少，与传统开放手术相比，临床效果类似，美容效果佳。

胰十二指肠切除术后胃肠吻合口套叠1例报道

FAILURE TO GAS ENEMA REDUCTION OF ACUTE INFANTILE INTUSSUSCEPTION (ANALYSIS OF 441 CASES)

To analyze the causes of failure to reduce acute infantile intussusception with gas enema. 441 cases of acute infantile intussusception in our hospital who failed to be reduced with gas-enema, and underwent the operative therapy were analyzed. Result: 92 cases (20.9%) were intestinal necrosis, 184 cases (41.7%) double intussusception, 27 cases (6.1%) organic pathological changes and 8 cases (1.8%) intestinal perforation caused by gas-enema reduction. All the cases had a successful recovery after surgery. Conclusion: The main causes of failure to reduction with gas-enema were as follows: ①double intussusception, ②intestinal necrosis, ③late for visiting a doctor, ④organic pathological changes, ⑤perforation (in the process of gas-enema reduction). The importance of early diagnosis is emphasized.

Value of Multi-Detector Row Spiral CT and 3-Dimensional Reconstruction Technique for Intussusception

Objective　To investigate the value of the multi-detector row spiral CT (MDCT) and 3-dimensional reconstruction technique for adult intussusception. Methods　Twenty-one patients with surgically and clinical following-up confirmed intussusception were retrospectively included into this study. Three patients had plain MDCT scan, 18 received contrast enhanced MDCT scan. The original images were reconstructed with multi-planar reconstruction (MPR) technique and all the images of 21 patients were divided into original image group and original image add MPR image group. Two abdominal radiologists analyzed the MDCT imaging and recorded respectively the accuracy rate and the confidence index of the doctor about following indexes: whether or not having intussusception, the location of intussusception, finding reason caused intussusception, whether or not having bowel wall ischemia and whether or not having bowel obstruction. The accuracy rate and the confidence index of the doctor were compared using a SPSS statistics software. Results　The accuracy rates about above indexes between original image group and original image add MPR image group were 90.5% (19/21) vs. 100% (21/21), 81.0% (17/21) vs. 95.2% (20/21), 85.7% (18/21) vs. 90.5% (19/21), 90.9% (10/11) vs. 90.9% (10/11) and 100% (11/11) vs. 100% (11/11) respectively, and there was no significant difference between original image group and original image add MPR image group (Pgt;0.05). For following indexes: whether or not having intussusception, the location of intussusception, finding reason caused intussusception, the confidence index of the doctor between original image add MPR image group and original image group had significant difference (5.00 vs. 4.24, 4.76 vs. 4.29, 4.29 vs. 3.71), and the confidence index of the doctor of original image add MPR image group exceeded that of original image group (Plt;0.05). Conclusions　MDCT plays a valuable role in diagnosis and location of intussusception, finding the reason caused intussusception and evaluation the hemodynamic impairment of being involved in bowel wall. Compared to simple axial image, axial image combine 3-dimensional reconstructed image can increase the diagnostic confidence of the doctor.

TREATMENT OF COLONIC INTUSSUSCEPTION IN ADULTS

目的 总结成人大肠套叠治疗经验。方法 回顾性分析我院1969～1998年收治的83例成人大肠套叠患者的临床资料。结果 经钡灌肠复位6例，手术治疗77例。肿瘤性大肠套叠60.2%，其中恶性肿瘤性套叠占64.0%。恶性肿瘤套叠手术切除5年生存率43.8%。结论 对成人大肠套叠治疗首选手术切除，慎用手术复位，不主张钡灌肠复位。

Clinical Value of Color Doppler Ultrasound in the Diagnosis of Intussusception in Children

ObjectiveTo study the clinical significance of color Doppler ultrasound in the diagnosis of intussusception in children. MethodsWe retrospectively analyzed the color Doppler ultrasound results of 150 children with intussusception confirmed by X-ray air enema and surgery between January 2010 and December 2012. ResultsThe 150 children included 18 cases of necrosis, and 132 cases of simple edema; there were 122 cases of ileocecal intussusception, 22 cases of colon, and 6 of small intestine. Surgical treatment was performed for 30 cases, and 120 cases were treated with X-ray air enema reduction. Ultrasonic diagnosis was correct in 144 cases with an accurate rate of 96.0%; 6 cases were misdiagnosed, and misdiagnosis rate was 4.0%. ConclusionUltrasound in the diagnosis of children intussusception is simple, rapid, non-invasive, with no side-effects of radiation exposure, and selection of this method clinically has a very important significance.

Small Intestine Intussusception Induced by Juvenile Polyps：A Systematic Literature Review

目的　提高对幼年性息肉致小肠套叠的诊治水平。方法　按检索策略，检索PubMed、中国生物医学文献数据库（CBM）、中文科技期刊全文数据库（CSJD）、中国期刊全文数据库（CJFD）及CNKI数字图书馆的相关文献，并结合笔者所在医院于2011年收治的1例幼年性息肉致小肠套叠病例资料，对该病进行一系统的描述。结果　共检出相关文献65篇，按纳入及排除标准，最后纳入6篇文献。共7例患者，临床表现为腹痛、呕吐5例，便血2例，贫血3例；经超声检查诊断4例；全组均行小肠切除肠吻合术，其中1例为腹腔镜辅助手术；有1例患者共实施了3次手术，最后死于恶液质，其余患者恢复较好。结论　幼年性息肉致小肠套叠为临床罕见疾病，超声检查仍为首选诊断方法；提高医师对该病的认识，术中彻底探查肠道，必要时术中行快速冰冻切片病理学检查，有望减少息肉遗留，改善患者的预后。