Velin P, Dupont D, Parizot P, Puig C, Grinda A
Service d'Anesthésie-Réanimation Hôpital Lenval pour Enfants, Nice.
Ann Fr Anesth Reanim. 1992;11(5):584-6. doi: 10.1016/s0750-7658(05)80764-6.
Two cases of postoperative intussusception (POI) are reported. Both children, 13 and 6 months old, had long and difficult surgery for abdominal neuroblastoma after four courses of chemotherapy. Obstruction of the small intestine occurred on the fifth postoperative day, after feeding had been started again, in the first child, and on the third day in the second one. Surgery revealed a loose ileo-ileal invagination of 10 and 15 cm respectively, which was easily reduced. The postoperative course was uneventful in both cases. Although POI is a classical complication of abdominal surgery, it is often forgotten. In the cases described, the first surgical procedure combined most causative factors for POI: young age, preoperative chemotherapy, prolonged general anaesthesia, extensive retroperitoneal dissection close to components of the neurovegetative system. The use of opioids for postoperative analgesia may be an additional risk factor, as they alter intestinal motility. Epidural analgesia with local anaesthetics should be preferred in such cases.
报告了两例术后肠套叠(POI)病例。两名儿童,分别为13个月和6个月大,在接受四个疗程的化疗后,因腹部神经母细胞瘤接受了长时间且困难的手术。第一个孩子在术后第五天再次开始喂食后出现小肠梗阻,第二个孩子在第三天出现梗阻。手术发现分别有10厘米和15厘米的松弛回肠-回肠套叠,很容易复位。两例患者术后过程均顺利。尽管POI是腹部手术的经典并发症,但它常常被遗忘。在所描述的病例中,首次手术合并了POI的大多数致病因素:年龄小、术前化疗、长时间全身麻醉、靠近神经植物系统成分的广泛腹膜后解剖。使用阿片类药物进行术后镇痛可能是一个额外的危险因素,因为它们会改变肠道蠕动。在这种情况下,应优先使用局部麻醉剂进行硬膜外镇痛。