Ein S H, Alton D, Palder S B, Shandling B, Stringer D
Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8.
Pediatr Surg Int. 1997 Jul;12(5-6):374-6. doi: 10.1007/BF01076943.
To evaluate the current management of the infant and child with intussusception, the medical records of 188 consecutive intussusception patients over 5 years (1985-1990) were reviewed and compared to our series from 25 years ago (1959-1968). The peak months changed from May and June to January and July. Duration of symptoms and signs prior to diagnosis increased by one-third to 35 h with, however, a decrease in the incidence of pain, vomiting, abdominal mass, and rectal blood. Air was the only contrast used for the hydrostatic enema in the present series and was tried in every case with 81% success; this is a major improvement from 45% in the old series. There were three perforations (1.4%) with air-enema attempts compared with 1 (0.2%) 25 years ago. Recently only 19% of patients required operation but 30% needed resection; 55% of the patients in the older series required operation and 20% needed resection. Ten percent of intussusceptions continue to be found spontaneously reduced at operation. There were many less pathologic lead points in the newer series. The recurrences increased from 4% to 7%, but their reduction rate also increased from 31% with barium to 100% with air. There were no deaths in the last 25 years.
为评估目前婴幼儿肠套叠的治疗情况，我们回顾了1985年至1990年连续5年收治的188例肠套叠患儿的病历，并与25年前（1959年至1968年）我们收治的病例系列进行了比较。发病高峰月份从5月和6月变为1月和7月。诊断前症状和体征的持续时间增加了三分之一，达到35小时，然而，疼痛、呕吐、腹部肿块及直肠出血的发生率却有所下降。在本病例系列中，空气是用于水压灌肠的唯一造影剂，且每例均尝试使用，成功率达81%；这与旧病例系列中的45%相比有了显著提高。空气灌肠尝试过程中有3例穿孔（1.4%），而25年前为1例（0.2%）。近期仅有19%的患者需要手术，但30%的患者需要切除；旧病例系列中有55%的患者需要手术，20%的患者需要切除。10%的肠套叠患者在手术时仍发现已自行复位。新病例系列中病理性引导点明显减少。复发率从4%增至7%，但复发后复位率也从钡剂复位时的31%增至空气复位时的100%。过去25年中无死亡病例。
