Guo Wan-Liang, Zhou Min, Wang Jian, Sheng Mao
Imaging Department, Affiliated Children's Hospital, Soochow University, Soochow 215003, China.
Zhonghua Yi Xue Za Zhi. 2010 Dec 21;90(47):3359-61.
To analyze the different success rates of air enema in intussusception cases at different ages and evaluate the value of plain film in assessing the pathogenetic condition of intussusception and intussusception with vascular compromise in children.
A retrospective analysis was performed on the success rates of air enema in 1119 pediatric cases of intussusception at different ages. The radiographic findings of 190 cases were analyzed. Air enema reduction failed in 95 cases. And 95 control cases were randomly selected for reduction by air enema. Their operative and pathological data were analyzed and compared with the findings of plain film. Intestinal obstruction with vascular compromise was analyzed by a comparison of plain film and pathology. The plain films of patients were analyzed by two experienced radiologist independently. Whenever there was dissension, they discussed and reached an agreement.
In all cases of intussusception, the successful reduction rate was 91.5%. The cases within 1-year-old were 627 cases, air enema success rate was 87.1% and the success rate of air enema was 97.2% in beyond 1-year-old group. There was significant difference between two groups (χ(2) = 36.01, P < 0.01). In 95 cases of failed air enema reduction, 14 cases were ileoileal, 10 ileocaecal and 25 ileocolic. And 44 cases were ileoilealcolic and 2 ileocoliccolic. Eleven cases had intestinal necrosis. Four cases had small bowel duplication cyst and 3 with Meckel's diverticulum. Intestinal obstruction with vascular compromise in plain film had a high concordance with pathology (kappa = 0.7128). The pathology type was somewhat correlated with the finding of plain film (P < 0.01). As assessed by plain film, there were intussusceptions with vascular compromise (n = 30) with a coffee-bean sign or banana sign, a paucity of bowel gas (n = 36), quadrant gas (n = 51) and mass or crescent (n = 73). Through an analysis between plain film signs and the onset of symptom by Spearman correlation (nonzero correlation = 20.67, P < 0.01), there was statistical significance.
The successful rate of air enema in intussusception is lower in within 1-year-old group than beyond 1-year-old group. The sign of plain film is more significant in assessing the pathogenetic conditions of intussusception. And it has a high concordance with pathology in assessing the intestinal obstruction with vascular compromise.
分析不同年龄段肠套叠病例空气灌肠复位的成功率，并评估腹部平片在评估儿童肠套叠及合并血管受压肠套叠病情中的价值。
回顾性分析1119例不同年龄段小儿肠套叠病例空气灌肠复位的成功率。对190例病例的X线表现进行分析。95例空气灌肠复位失败。随机选取95例对照病例行空气灌肠复位。分析其手术及病理资料，并与腹部平片表现进行比较。通过腹部平片与病理结果对比分析合并血管受压的肠梗阻情况。由两位经验丰富的放射科医师独立分析患者的腹部平片。如有分歧，则进行讨论并达成一致意见。
所有肠套叠病例中，复位成功率为91.5%。1岁以内病例627例，空气灌肠成功率为87.1%，1岁以上组空气灌肠成功率为97.2%。两组间差异有统计学意义（χ(2)=36.01，P<0.01）。95例空气灌肠复位失败病例中，回-回型14例，回-盲型10例，回-结肠型25例。回-回-结肠型44例，结肠-结肠型2例。11例发生肠坏死。4例有小肠重复囊肿，3例有美克尔憩室。腹部平片显示合并血管受压的肠梗阻与病理结果具有较高的一致性（kappa=0.7128）。病理类型与腹部平片表现有一定相关性（P<0.01）。腹部平片评估显示，合并血管受压的肠套叠（n=30）有咖啡豆征或香蕉征、肠气减少（n=36）、象限性积气（n=51）及肿块或新月征（n=73）。通过Spearman相关性分析腹部平片征象与症状发作情况（非零相关性=20.67，P<0.01），具有统计学意义。
肠套叠空气灌肠复位成功率1岁以内组低于1岁以上组。腹部平片征象在评估肠套叠病情方面更具意义。在评估合并血管受压的肠梗阻方面与病理结果具有较高的一致性。
