Navarro Oscar M, Daneman Alan, Chae Anita
Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, ON M5G 1X8, Canada.
AJR Am J Roentgenol. 2004 May;182(5):1169-76. doi: 10.2214/ajr.182.5.1821169.
The nonoperative management of intussusception continues to evolve and is the subject of ongoing debate. Our purpose was to assess our current enema reduction rate and to focus on two specific issues that have received little attention in the literature: first, the value and safety of using delayed, repeated reduction attempts and, second, the management of intussusceptions due to lead points.
We performed a retrospective analysis of all intussusception cases seen at the Hospital for Sick Children, Toronto, Canada, a tertiary pediatric hospital, from May 1999 to December 2002.
There were 163 children with a total of 219 intussusceptions. Enema reduction was attempted in 211 (96%). Reduction rate with air enema was 90.2%. Delayed reduction attempts were used in 25 patients (15.3%) in 26 intussusceptions (12.3%) and were successful in 50% of the cases. Lead points were documented in 13 children (8%); sonography depicted the lead points in seven (53.8%) of the 13. The reduction rate of intussusceptions due to lead points was 63.6% (14/22).
Air enema associated with the use of delayed, repeated reduction attempts is a safe and effective approach for intussusception reduction with a high success rate. Delayed, repeated reduction attempts should be considered when the initial attempt manages to move the intussusceptum and the patient remains clinically stable. The management of intussusceptions due to lead points remains a challenge. Sonography does not depict all lead points, and the indication for other imaging studies should be tailored according to each particular patient. We recommend attempted enema reduction in all patients with lead points.
肠套叠的非手术治疗方法不断发展，仍是当前争论的焦点。我们的目的是评估目前灌肠复位率，并关注文献中较少提及的两个具体问题：第一，延迟、重复复位尝试的价值和安全性；第二，由肠套叠引导点引起的肠套叠的处理。
我们对1999年5月至2002年12月在加拿大多伦多病童医院（一家三级儿科医院）就诊的所有肠套叠病例进行了回顾性分析。
共有163名儿童发生了219次肠套叠。211例（96%）尝试了灌肠复位。空气灌肠复位率为90.2%。25例患者（15.3%）在26次肠套叠（12.3%）中进行了延迟复位尝试，其中50%的病例成功。13名儿童（8%）记录有引导点；超声检查在13例中的7例（53.8%）显示了引导点。由引导点引起的肠套叠复位率为63.6%（14/22）。
空气灌肠联合延迟、重复复位尝试是一种安全有效的肠套叠复位方法，成功率高。当初次尝试使套叠肠管移动且患者临床情况稳定时，应考虑延迟、重复复位尝试。由引导点引起的肠套叠的处理仍然是一个挑战。超声检查并非能显示所有引导点，其他影像学检查的指征应根据每个具体患者进行调整。我们建议对所有有引导点的患者尝试灌肠复位治疗。
