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目的提高小儿肠套叠灌肠复位率,避免肠穿孔意外发生。方法术前一律肌肉注射654-2,在无麻醉下取头低足高俯卧位插入Fuler’s肛管,灌肠器内放入10~20 ml液体石蜡,术者手握带压力表的加压气球,保持低压(80 mm Hg内),慢速注气,透视观察套头部的运动变化,以套头部退出回盲部软组织块影消失,小肠进入气体为复位标准。术后禁食24 h以静脉营养,抗感染、止血、解痉等药物治疗,24 h后逐量进食。结果本组45例中2例超过48 h,套头部位于横结肠脾曲,气压加至80 mmHg时套头部无明显移动,结合病史不排除肠坏死,未继续作复位术。43例全部行本法灌肠复位术均获成功。复位率94%~95%。其中2例进食过早12 h复发,行第二次灌肠复位亦获成功。43例(45次)术中未出现肠壁穿孔等意外发生。肠坏死特征性表现:气压升至80 mm Hg时套头部无明显运动。结论于头低足高俯卧位,利用液体石蜡、654-2的药物特征性作用提高灌肠复位率,是小儿肠套叠的理论基础。低压慢速注气是避免肠壁穿孔的重要手段。本方法简便易行、安全可靠、复位率高。
Objective To improve children intussusception enema reduction rate to prevent intestinal perforation accident. [Methods] All patients were intramuscularly injected with 654-2 intramuscularly before anesthesia. Fuer’s anal canal was inserted into the low-height and high-prone position without anesthesia. 10 ~ 20 ml liquid paraffin was placed in the appliance. The surgeon held a pressurized balloon with a pressure gauge, Maintain low pressure (80 mm Hg), slow gas injection, observe changes in the head movement of the sleeve, exit the sleeve and exit the soft tissue block of the ileocecal shadow disappears, enter the gas into the small intestine for the reset standard. Postoperative fasting 24 h to intravenous nutrition, anti-infection, bleeding, antispasmodic and other drug treatment, 24 h after eating. Results The group of 45 cases of 2 cases over 48 h, set the head in the transverse colon splenic curvature, pressure increased to 80 mmHg hematoma no significant movement, combined with history does not rule out intestinal necrosis, did not continue to be reset. All 43 cases of this method enema reduction were successful. Reset rate of 94% to 95%. Among them, 2 cases recurred 12 hours earlier and the second enema reduction was successful. In 43 cases (45 times), there were no accidents such as intestinal perforation. Characteristic manifestations of intestinal necrosis: no significant movement of the cap when the pressure rose to 80 mm Hg. Conclusions It is the theoretical basis of pediatric intussusception that the rate of enema reduction can be increased by the characteristic action of liquid paraffin and 654-2 in the prone position of lower head and upper foot. Slow low-pressure gas injection is to prevent intestinal perforation of an important means. The method is simple, safe and reliable, high reset rate.