Palder S B, Ein S H, Stringer D A, Alton D
Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr Surg. 1991 Mar;26(3):271-4; discussion 274-5. doi: 10.1016/0022-3468(91)90501-j.
At The Hospital For Sick Children, the use of air has recently replaced the use of barium in the reduction of intussusceptions. The purpose of this study was to review the results from 200 consecutive patients with intussusceptions, 100 patients treated with barium enema and 100 patients treated with air enema. The groups were similar with regard to sex, average and median ages, and presenting symptoms and signs. Successful reduction was achieved in 75% of episodes of intussusception treated with barium enema and 76% treated with air enema. Failure of either modality showed a high association with the presence of either a lead point or an ileoileal or ileoileocolic intussusception. Among those cases of unsuccessful reduction, operation was performed in all 59 cases; resection in 30 cases, manual reduction in 19, and spontaneous reduction was found in 10. There were three perforations during attempted reduction with barium and two with air. All perforations were treated by resection and primary anastomosis. There were 18 recurrent intussusceptions following barium enema reduction and nine following air enema reduction. Therefore, with the lower absorption of x-rays by air and the relatively inert nature of air (compared with barium in the event of a perforation), we feel that air enema is the treatment of choice in the initial management of intussusception.
在病童医院，空气灌肠最近已取代钡剂灌肠用于肠套叠复位。本研究的目的是回顾连续200例肠套叠患者的治疗结果，其中100例接受钡剂灌肠治疗，100例接受空气灌肠治疗。两组在性别、平均年龄和中位年龄以及症状和体征方面相似。钡剂灌肠治疗的肠套叠复位成功率为75%，空气灌肠治疗的成功率为76%。两种方法治疗失败均与存在引导点或回肠-回肠或回肠-回结肠套叠高度相关。在复位失败的病例中，59例均进行了手术；30例行切除术，19例行手法复位，10例自行复位。钡剂灌肠复位时有3例穿孔，空气灌肠时有2例穿孔。所有穿孔均行切除术和一期吻合术。钡剂灌肠复位后有18例复发性肠套叠，空气灌肠复位后有9例。因此，由于空气对X射线的吸收较低，且空气性质相对惰性（与穿孔时的钡剂相比），我们认为空气灌肠是肠套叠初始治疗的首选方法。
