| Objective To provide the basis for the diagnosis and treatment of pediatric acute intussusceptions,decrease the misdiagnosis and missed diagnosis of intussusceptions and improve the efficacy and safety of the clinical treatment for intussusceptions by probing the clinical features,diagnosis and treatment of the infantile acute intussusception cases in our department in recent two years.Materals and Methods The clinical data of 417 pediatric acute intussusception cases treated in our department from November 2013 to October 2015 were retrospectively analyzed.To analyze the clinical manifestations,type B ultrasound diagnosis and the recovery efficacy of the air enema under X-ray fluoroscopy.Results1.87 cases of infantile acute intussusception had the four main symptoms meanwhile(paroxysmal crying,vomiting,bloody stools and abdominal mass),accounting for 20.8% in total 417 cases.2.371 cases of intussusception were detected by abdominal ultrasonography in total 417 cases,the positive rate is 88.9%3.126 cases had pre-hospital bloody stools accounting for 30.2% in total 417 cases of intussusceptions,198 cases had bloody stools after glycerin enema in 291 cases of without bloody stools in the beginning,accounting for 68.0%,the total of the above mentioned two groups accounted for 77.7% of the total number of cases.4.397 cases succeded by low pressure air enema diagnosis,air enema treatment and pushing massage technique under X-ray monitoring,the success rate attained95.2%.20 cases failed in recovery,1 case perforated.Conclusion1.Only a small number of cases of pediatric acute intussusception have typicalclinical tetralogy,we should pay attention to atypical cases in order to reduce the missed diagnosis and misdiagnosis for acute intussusception in children.The application of glycerin can improve the discovery probability of bloody stools.2.The abdominal ultrasonography is the preferred method for early diagnosis of intussusceptions with high diagnostic accuracy in pediatric intussusceptions.3.There is false negative result in air enema treatment for infantile acute intussusception.The reduction condition of intussusception should be further confirmed before surgery for children with enema failure.Objective To explore the related factors of air pressure selection for air enema,which could provide a basis for its application in clinical diagnosis and treatment of intussusception.Materials and Methods:From November 2012 to October 2015,315 cases of children patients who had at least one or more four symptoms(paroxysmal abdominal pain/ crying,vomiting,bloody stools and abdominal mass)aged from 6 months to 12 months were considered as intussusception in department of pediatric surgery in our hospital.The children patients were randomly divided into three groups named group one,group two,and group three respectively.The initial air enema pressure is 6KPa for group one children patients,7KPa for group two children patients and 8KPa for group three children patients.The factors related to pressure selection for air enema such as age,gender,disease duration,time consumption for success of enema,the location of intussusception head and the final pressure for successful enema were judged.Results:1.The average time consumed for air enema success of group one,group two and group 3 was 4.30 ±1.17 min,4.38±1.42 min and 4.06±0.91 min respectively.All P values were greater than 0.05 with pair-wise comparison in three groups,the difference between any two groups was not statistically significant.2.The head position of intussusception was judged during air enema.The head position of intussusception of 147 children patients located between ileocecum and hepatic flexure of the colon,90 cases located at transverse colon and 60 cases located at splenic flexure of colon.The average time of air enema consumed for the children patients with head position of intussusceptions at ascending colon was3.59±0.78 min,that for transverse colon was 4.40±0.80 min and that for splenic flexureof colon was 5.50±1.37 min.All P values were less than 0.05 with pair-wise comparison in three groups,the difference between any two groups was statistically significant.3.The lowest final pressure of air enema recovery for children patients with tussusception head located between ileocecum and hepatic flexure of the colon was7 KPa,the highest final pressure of that was 10 KPa and the average final pressure of that was 8.70±0.87 KPa.The lowest final pressure of air enema recovery for children patients with tussusception head located at transverse colon was 8KPa,the highest final pressure of that was 10 KPa and the average final pressure of that was8.70±0.87 KPa.The lowest final pressure of air enema recovery for children patients with tussusception head located at splenic flexure of colon was 8KPa,the highest final pressure of that was 12 KPa and the average final pressure of that was 9.80±1.41 KPa.pair-wise comparison between three groups,P values were less than 0.05,the difference is statistically significant.Conclusion:1.There is no correlation between time consumed for successful air enema and the initial pressure for air enema.The increased initial pressure do not shorten the time consumed for air enema.We suggest that the initial pressure enema should be set to 6kpa.2.The required time and eventually required pressure for successful enema is associated with nested head position,we suggest that the appropriate pressure should be more rapidly selected according to the nested head position of intussusception,which can shorten the time for the enema reduction. |
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