Peh W C, Khong P L, Chan K L, Lam C, Cheng W, Lam W W, Mya G H, Saing H, Leong L L, Low L C
Department of Diagnostic Radiology, University of Hong Kong, Queen Mary Hospital, Hong Kong.
AJR Am J Roentgenol. 1996 Nov;167(5):1237-41. doi: 10.2214/ajr.167.5.8911188.
Currently, the standard methods for therapeutic reduction of intussusception in children involve considerable ionizing radiation. This study tested the effectiveness of sonographically guided hydrostatic reduction of intussusception using Hartmann's solution, a fluid with near-physiologic composition.
Between March 1, 1994, and January 31, 1996, all children clinically suspected of having intussusception were evaluated by sonography. Those with positive findings on sonography were entered into the study and underwent confirmatory sonographically guided meglumine diatrizoate enema. During continuous sonographic monitoring, we used Hartmann's solution for attempted reduction of intussusception. Criteria for successful reduction were disappearance of the intussusceptum and passage of fluid through the ileocecal valve. Another sonographically guided meglumine diatrizoate enema was used to confirm successful reduction.
We detected 25 consecutive intussusceptions in 22 patients. The patients were 12 girls and 10 boys, with a mean age of 14 months (range, 1-72 months). Sonograms revealed in all patients doughnut or pseudokidney signs or both. The sites of intussusception were the transverse colon (17 of 25), hepatic flexure (4 of 25), ascending colon (2 of 25), splenic flexure (1 of 25), and descending colon (1 of 25). Other findings were dilated fluid-filled small bowel (11 of 25) and free intraperitoneal fluid (9 of 25). The success rate of our sonographically guided attempts at hydrostatic reduction was 76% (19 of 25). Success was proven by meglumine diatrizoate enema in all 19 patients. The mean time of the reduction procedure was 18 min (range, 2-45 min). No complications occurred. All six patients in whom hydrostatic reduction was unsuccessful underwent surgery. Five of these patients had ileoileocolic intussusceptions. On sonography, when surrounded by fluid, ileoileocolic intussusceptions had a typically complex, fronded appearance. The remaining patient in whom hydrostatic reduction was unsuccessful had ileocolic intussusception. Of six ileoileocolic intussusceptions, one was hydrostatically reduced and a second was converted into an ileoileal intussusception before requiring surgery. The other four intussusceptions were surgically treated.
Our data suggest that sonographically guided hydrostatic reduction with Hartmann's solution can be used to treat ileocolic intussusception and to diagnose ileoileocolic intussusception.
目前，儿童肠套叠治疗性复位的标准方法涉及大量电离辐射。本研究测试了使用成分接近生理状态的哈特曼溶液在超声引导下进行肠套叠水压复位的有效性。
1994年3月1日至1996年1月31日期间，对所有临床怀疑患有肠套叠的儿童进行超声检查。超声检查结果阳性的患儿纳入本研究，并接受超声引导下的泛影葡胺灌肠以进行确诊。在持续超声监测下，我们使用哈特曼溶液尝试进行肠套叠复位。复位成功的标准为套入部消失且液体通过回盲瓣。另一次超声引导下的泛影葡胺灌肠用于确认复位成功。
我们在22例患者中连续检测到25例肠套叠。患者中12例为女孩，10例为男孩，平均年龄14个月（范围1 - 72个月）。所有患者的超声检查均显示出“同心圆”或“假肾”征或两者皆有。肠套叠部位为横结肠（25例中的17例）、肝曲（25例中的4例）、升结肠（25例中的2例）、脾曲（25例中的1例）和降结肠（25例中的1例）。其他表现为扩张的充满液体的小肠（25例中的11例）和腹腔内游离液体（25例中的9例）。我们超声引导下进行水压复位的成功率为76%（25例中的19例）。所有19例患者经泛影葡胺灌肠证实复位成功。复位过程的平均时间为18分钟（范围2 - 45分钟）。未发生并发症。水压复位未成功的6例患者均接受了手术。其中5例患者为回结型肠套叠。在超声检查中，当被液体包围时，回结型肠套叠通常呈现典型的复杂、叶状外观。水压复位未成功的其余1例患者为回盲型肠套叠。在6例回结型肠套叠中，1例经水压复位成功，另1例在需要手术前转变为回肠型肠套叠。其他4例肠套叠接受了手术治疗。
我们的数据表明，超声引导下使用哈特曼溶液进行水压复位可用于治疗回盲型肠套叠并诊断回结型肠套叠。
