Chan K L, Saing H, Peh W C, Mya G H, Cheng W, Khong P L, Lam C, Lam W W, Leong L L, Low L C
Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
J Pediatr Surg. 1997 Jan;32(1):3-6. doi: 10.1016/s0022-3468(97)90079-8.
A comparison was made of the efficacy of ultrasound guided Hartmann's solution hydrostatic reduction on 23 patients (US group) with the same number of consecutive patients in whom hydrostatic reduction was done by barium enema (BE group) under fluoroscopy for childhood intussusception. The US group was diagnosed by ultrasound scan and reduction was attempted under the guidance of ultrasonography with Hartmann's solution at 100 mm Hg pressure. Excluded were patients older than 12 years, patients in shock, patients with peritonitis, bowel perforation, and gross abdominal distension as well as recurrent intussusception of more than three episodes. There were three patients excluded in this group. The diagnosis of intussusception and complete reduction were confirmed by gastrografin enema. This US group had three recurrences (3 of 26, 11.5%), one lead point (1 of 23, 4.4%), and 19 successful reductions (19 of 26, 73%). Incidentally, there were also three patients excluded in this period of barium enema reduction. There was only one recurrence (1 of 24, 4.2%), one leadpoint (1 of 23, 4.4%), and 12 successful reductions (12 of 24, 50%) in these 23 BE patients. The success rates for the ileo-colic intussusceptions with Hartmann's solution reduction and barium enema reduction were 91% (19 of 21) and 55% (12 of 22), respectively (P = .00865). There was no complication in either group, and the accuracy of diagnosing a complete reduction was 100% in both forms of reduction. Hence, ultrasound-guided hydrostatic reduction for childhood ileocolic intussusception is preferred because it is safe, accurate, has a higher success rate, and can avoid radiation exposure risk.
对23例儿童肠套叠患者（超声组）采用超声引导下哈特曼溶液水压复位的疗效与连续23例在透视下采用钡剂灌肠（钡剂灌肠组）进行水压复位的患者进行了比较。超声组通过超声扫描诊断，并在超声引导下用哈特曼溶液于100毫米汞柱压力下尝试复位。排除年龄超过12岁的患者、休克患者、患有腹膜炎、肠穿孔和严重腹胀的患者以及复发性肠套叠超过三次的患者。该组有3例患者被排除。肠套叠的诊断和完全复位通过泛影葡胺灌肠确认。该超声组有3例复发（26例中的3例，11.5%），1个套入点（23例中的1例，4.4%），19例成功复位（26例中的19例，73%）。顺便说一下，在这段钡剂灌肠复位期间也有3例患者被排除。这23例钡剂灌肠组患者中只有1例复发（24例中的1例，4.2%），1个套入点（23例中的1例，4.4%），12例成功复位（24例中的12例，50%）。采用哈特曼溶液复位和钡剂灌肠复位的回结肠型肠套叠的成功率分别为91%（21例中的19例）和55%（22例中的12例）（P = 0.00865）。两组均无并发症，两种复位方式诊断完全复位的准确率均为100%。因此，超声引导下儿童回结肠型肠套叠水压复位更受青睐，因为它安全、准确、成功率更高，并且可以避免辐射暴露风险。
