小儿急性肠套叠空气灌肠及水压灌肠治疗效果比较
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摘要
目的比较超声监视下水压灌肠与X射线下空气灌肠治疗小儿肠套叠的临床效果。方法选取2008年8月至2017年8月收治的肠套叠患儿4 344例,按照治疗方法不同,设为2个时段。2008年8月至2012年11月行空气灌肠(2 056例),2012年12月至2017年8月行水压灌肠(2 288例)。统计两种治疗方法的整复成功率、失败率、复发率等数据,比较两种治疗方法的疗效及并发症情况。结果水压灌肠组整复成功率为96.55%(2 209/2 288),高于空气灌肠组的90.32%(1 857/2 056),差异有统计学意义(P<0.05);但水压灌肠组复发率(10.50%)高于空气灌肠组(7.22%),差异有统计学意义(P<0.05);水压灌肠组穿孔率(0.57%)低于空气灌肠组(0.83%),差异有统计学意义(P<0.05)。病人的发病时间与复位率呈负相关。结论与X射线下空气灌肠比较,超声监视下水压灌肠对小儿肠套叠复位成功率更高,严重并发症发生率更低,值得临床推广。
Objective To compare the clinical effect of water pressure enema under ultrasound monitoring and air enema under X-ray for intussusception in children.Methods 4 344 children with intussusception admitted from August 2008 to August 2017 were selected.From August 2008 to November 2012, 2 056 cases were treated with air enema, and from December 2012 to August 2017, 2 288 cases were treated with water pressure enema.The data of rectification success rate, failure rate and recurrence rate of the two treatment methods were collected, and the curative effect and complications of the two treatment methods were compared.Results The completion rate of the hydrostatic enema group was 96.55%(2 209/2 288), higher than that of the air enema group(90.32%, 1 857/2 056), and the difference was statistically significant(P<0.05).However, the recurrence rate of the water pressure enema group was 10.50%, higher than that of the air enema group(7.22%), and the difference was statistically significant(P<0.05).The perforation rate of the hydraulic enema group was 0.57%, lower than that of the air enema group, and the difference was statistically significant(P<0.05).The onset time was negatively correlated with the reduction rate.Conclusion Compared with air enema under X-ray, the reduction rate of intussusception in children subject to water pressure enema under ultrasonic monitoring is higher and the incidence of serious complications is lower, which is worthy of clinical promotion.
Objective To compare the clinical effect of water pressure enema under ultrasound monitoring and air enema under X-ray for intussusception in children.Methods 4 344 children with intussusception admitted from August 2008 to August 2017 were selected.From August 2008 to November 2012, 2 056 cases were treated with air enema, and from December 2012 to August 2017, 2 288 cases were treated with water pressure enema.The data of rectification success rate, failure rate and recurrence rate of the two treatment methods were collected, and the curative effect and complications of the two treatment methods were compared.Results The completion rate of the hydrostatic enema group was 96.55%(2 209/2 288), higher than that of the air enema group(90.32%, 1 857/2 056), and the difference was statistically significant(P<0.05).However, the recurrence rate of the water pressure enema group was 10.50%, higher than that of the air enema group(7.22%), and the difference was statistically significant(P<0.05).The perforation rate of the hydraulic enema group was 0.57%, lower than that of the air enema group, and the difference was statistically significant(P<0.05).The onset time was negatively correlated with the reduction rate.Conclusion Compared with air enema under X-ray, the reduction rate of intussusception in children subject to water pressure enema under ultrasonic monitoring is higher and the incidence of serious complications is lower, which is worthy of clinical promotion.
引文
[1] 霍文正,刘斌,白锡波.B超监测水压灌肠治疗小儿肠套叠的临床分析[J].中国医药指南,2014,12(31):146.
[2] 佘亚雄.婴儿肠套叠治疗的进展一结肠注气整复法[J].中华外科杂志,1965, 13(1):94-94.
[3] 王松楠,李清华,周岩.超声下水压灌肠治疗肠套叠技术改进及评价[J].中华小儿外科杂志,2016,37(8):597-601.
[4] 陈桂林,时胜利.阿托品在小儿肠套叠空气灌肠整复术的应用价值[J].中国实用医药,2011,6(9):171.
[5] 张钦富,杨顺勤,程晓军,等.53台医用诊断X射线机质控检测结果分析[J].中国辐射卫生,1997,6(1):35-36.
[6] 付茂利.彩色多普勒超声诊断小儿肠套叠的临床价值[J].医学影像学杂志,2015,25(1):96-98.
[7] 宋连杰,单叔煤,李贵斌.实时超声水压灌肠复位治疗小儿肠套叠疗效观察[J].中国医疗设备,2010,25(11):141.
[8] Karada A,Abbaso lu L,Sever N,et al.Ultrasound-guided hydrostatic reduction of intussusception with saline:Safe and effective[J].Pediatr Surg,2015,50(9):1563-1565.DOI:10.1016/j.jpedsurg.2015.03.046.
[9] Lam SH,Wise A,Yenter C,et al.Emergency bedside ultrasound for the diagnosis of pediatric intussusception:a retrospective review[J].World J Emerg Med,2014,5(4):255-258.DOI:10.5847/wjem.j.issn.1920-8642.2014.04.002.
[10] 胡良勇.超声诊断小儿急性肠套叠的价值[J].中国医学影像学杂志,2014,22(7):511-514.
[11] Tan N,Teoh YL,Phua KB,et al.An update of piadiatric intussusception incidencein singapore:1997-2007,11 years of intussusception surveillance[J].Ann Acad Med Singapore,2009,38(8):690-692.
[12] Latipov R,Khudoyorov R,Flem E.Childhood intussusception in Uzbekistan:Analysis of retrospective surveillance data[J].BMC Pediatr,2011,11(1):22.DOI:10.1186/1471-2431-11-22.
[13] 闰学强,郑楠楠,叶国刚,等.复发性肠套叠的临床特点及治疗[J].实用儿科临床杂志,2011,26(23):1789-1790.
[14] 宋连杰,单叔煤,李贵斌.实时超声水压灌肠复位治疗小儿肠套叠疗效观察[J].中国医疗设备,2010,25(11):141.
[15] 轩爱军,杨国强,王立新.间苯三酚对小儿肠套叠水压灌肠复发率的影响[J].中国基层医药,2014,21(13):1945-1946.
[2] 佘亚雄.婴儿肠套叠治疗的进展一结肠注气整复法[J].中华外科杂志,1965, 13(1):94-94.
[3] 王松楠,李清华,周岩.超声下水压灌肠治疗肠套叠技术改进及评价[J].中华小儿外科杂志,2016,37(8):597-601.
[4] 陈桂林,时胜利.阿托品在小儿肠套叠空气灌肠整复术的应用价值[J].中国实用医药,2011,6(9):171.
[5] 张钦富,杨顺勤,程晓军,等.53台医用诊断X射线机质控检测结果分析[J].中国辐射卫生,1997,6(1):35-36.
[6] 付茂利.彩色多普勒超声诊断小儿肠套叠的临床价值[J].医学影像学杂志,2015,25(1):96-98.
[7] 宋连杰,单叔煤,李贵斌.实时超声水压灌肠复位治疗小儿肠套叠疗效观察[J].中国医疗设备,2010,25(11):141.
[8] Karada A,Abbaso lu L,Sever N,et al.Ultrasound-guided hydrostatic reduction of intussusception with saline:Safe and effective[J].Pediatr Surg,2015,50(9):1563-1565.DOI:10.1016/j.jpedsurg.2015.03.046.
[9] Lam SH,Wise A,Yenter C,et al.Emergency bedside ultrasound for the diagnosis of pediatric intussusception:a retrospective review[J].World J Emerg Med,2014,5(4):255-258.DOI:10.5847/wjem.j.issn.1920-8642.2014.04.002.
[10] 胡良勇.超声诊断小儿急性肠套叠的价值[J].中国医学影像学杂志,2014,22(7):511-514.
[11] Tan N,Teoh YL,Phua KB,et al.An update of piadiatric intussusception incidencein singapore:1997-2007,11 years of intussusception surveillance[J].Ann Acad Med Singapore,2009,38(8):690-692.
[12] Latipov R,Khudoyorov R,Flem E.Childhood intussusception in Uzbekistan:Analysis of retrospective surveillance data[J].BMC Pediatr,2011,11(1):22.DOI:10.1186/1471-2431-11-22.
[13] 闰学强,郑楠楠,叶国刚,等.复发性肠套叠的临床特点及治疗[J].实用儿科临床杂志,2011,26(23):1789-1790.
[14] 宋连杰,单叔煤,李贵斌.实时超声水压灌肠复位治疗小儿肠套叠疗效观察[J].中国医疗设备,2010,25(11):141.
[15] 轩爱军,杨国强,王立新.间苯三酚对小儿肠套叠水压灌肠复发率的影响[J].中国基层医药,2014,21(13):1945-1946.