肠套叠缺血再灌注损伤的可行性研究(1)
摘要：目的 探讨肠套叠缺血再灌注损伤的误诊因素及发病机制，优化临床路径，提高治愈率。方法 回顾性分析笔者所在医院2010年1月～2015年12月收治的28例重症小儿肠套叠患者的临床资料。结果 11例行可疑肠管切除，均治愈。17例给予保守观察，5例肠管无坏死穿孔一期治愈，12例术后出现肠缺血再灌注损伤，迟发性肠穿孔肠坏死，经肠造瘘并3月后肠吻合术治愈。两种治疗方法在手术时间(105.5±14.37)min vs (56.7±13.53)min、术中出血量(30.1±1.57)ml vs (12.1±1.13)ml、术后肠梗阻发生率(0 vs 82.30%)、肠坏死发生率(0 vs 70.50%)、切口感染发生率(8.00% vs 0)、术后住院时间(12.8±1.7)d vs (7.8±1.1)d上比较，差异均无统计学意义。结论 对于发病时间超过72 h，严重血便伴休克，术中肠管血运差可疑坏死的肠套叠患者，易出现肠缺血再灌注损伤，误诊率高，预后难评估，充分液体复苏，积极切除可疑肠管，改善微循环，可提高治愈率。
关键词：肠套叠；缺血再灌注；复苏
, 百拇医药
中图分类号：R574.3 文献标识码：A 文章编号：1006-1959(2017)24-0064-02
Feasibility Study on Ischemia Reperfusion Injury of Intussusception
ZHANG Dong，HUANG Yong
(Sihong Maternity and Child Hospital，Sihong 223900，Jiangsu，China)
Abstract：Objective To investigate the misdiagnosis and pathogenesis of intussusception and ischemia-reperfusion injury，to optimize the clinical path and improve the cure rate.Methods The clinical data of 28 patients with severe pediatric intussusception were retrospectively analyzed in our hospital from January 2010 to December 2015.Results 11 cases of suspected bowel resection，were cured.17 cases were given conservative observation，5 cases of intestinal no necrosis perforation of a cure，12 cases of intestinal ischemia-reperfusion injury，delayed intestinal perforation of intestinal necrosis， intestinal fistula and intestinal anastomosis after 3 months.Two kinds of treatment methods in operation time(105.5±14.37)min vs (56.7±13.53)min，the amount of bleeding(30.1±1.57)mL vs(12.1±1.13)mL，the incidence of postoperative intestinal obstruction(0.0%vs82.3%)，the incidence of intestinal necrosis(0.0%vs70.5%)，the incidence of incision infection(8.0%vs0.0%)，hospitalization time after operation(12.8±1.7)d vs (7.8±1.1)d comparison，the difference was not statistically significant.Conclusion The onset time of more than 72 h，severe bloody diarrhea with shock，intraoperative blood tube suspicious necrosis with intussusception，prone to intestinal ischemia reperfusion injury，the misdiagnosis rate is high，difficult to assess the prognosis， fluid resuscitation，positive resection of suspected bowel，improve microcirculation，can improve the cure rate.
, 百拇医药
Key words：Intussusception；Ischemia reperfusion；Resuscitation
腸套叠是指肠管的一部分及其相应肠系膜套入邻近肠腔内的一种肠梗阻，是婴幼儿时期常见急腹症，好发于4～10个月患儿。对于发病时间>72 h，伴有严重血便及休克的患儿，易发生肠缺血再灌注损伤[1]。为了分析肠缺血再灌注损伤的发病机制，预防及处理措施，降低死亡率，对肠套叠缺血再灌注损伤病例进行临床资料统计及综合分析。我院2010年1月～2015年12月对232例空气灌肠禁忌症患儿进行手术治疗。28例重症肠套叠，术中肠管血运差，可疑坏死，全部经术前液体复苏，11例术中切除可疑肠管，17例行套叠复位后肠管保守观察。切除病例组均治愈，无术后并发症发生。保守观察组，5例肠管无坏死穿孔一期治愈，12例术后出现肠缺血再灌注损伤，迟发性肠穿孔肠坏死，经肠造瘘并3月后肠吻合术治愈，现报道如下。, 百拇医药(张冬 黄永)
关键词：肠套叠；缺血再灌注；复苏
, 百拇医药
中图分类号：R574.3 文献标识码：A 文章编号：1006-1959(2017)24-0064-02
Feasibility Study on Ischemia Reperfusion Injury of Intussusception
ZHANG Dong，HUANG Yong
(Sihong Maternity and Child Hospital，Sihong 223900，Jiangsu，China)
Abstract：Objective To investigate the misdiagnosis and pathogenesis of intussusception and ischemia-reperfusion injury，to optimize the clinical path and improve the cure rate.Methods The clinical data of 28 patients with severe pediatric intussusception were retrospectively analyzed in our hospital from January 2010 to December 2015.Results 11 cases of suspected bowel resection，were cured.17 cases were given conservative observation，5 cases of intestinal no necrosis perforation of a cure，12 cases of intestinal ischemia-reperfusion injury，delayed intestinal perforation of intestinal necrosis， intestinal fistula and intestinal anastomosis after 3 months.Two kinds of treatment methods in operation time(105.5±14.37)min vs (56.7±13.53)min，the amount of bleeding(30.1±1.57)mL vs(12.1±1.13)mL，the incidence of postoperative intestinal obstruction(0.0%vs82.3%)，the incidence of intestinal necrosis(0.0%vs70.5%)，the incidence of incision infection(8.0%vs0.0%)，hospitalization time after operation(12.8±1.7)d vs (7.8±1.1)d comparison，the difference was not statistically significant.Conclusion The onset time of more than 72 h，severe bloody diarrhea with shock，intraoperative blood tube suspicious necrosis with intussusception，prone to intestinal ischemia reperfusion injury，the misdiagnosis rate is high，difficult to assess the prognosis， fluid resuscitation，positive resection of suspected bowel，improve microcirculation，can improve the cure rate.
, 百拇医药
Key words：Intussusception；Ischemia reperfusion；Resuscitation
腸套叠是指肠管的一部分及其相应肠系膜套入邻近肠腔内的一种肠梗阻，是婴幼儿时期常见急腹症，好发于4～10个月患儿。对于发病时间>72 h，伴有严重血便及休克的患儿，易发生肠缺血再灌注损伤[1]。为了分析肠缺血再灌注损伤的发病机制，预防及处理措施，降低死亡率，对肠套叠缺血再灌注损伤病例进行临床资料统计及综合分析。我院2010年1月～2015年12月对232例空气灌肠禁忌症患儿进行手术治疗。28例重症肠套叠，术中肠管血运差，可疑坏死，全部经术前液体复苏，11例术中切除可疑肠管，17例行套叠复位后肠管保守观察。切除病例组均治愈，无术后并发症发生。保守观察组，5例肠管无坏死穿孔一期治愈，12例术后出现肠缺血再灌注损伤，迟发性肠穿孔肠坏死，经肠造瘘并3月后肠吻合术治愈，现报道如下。, 百拇医药(张冬 黄永)
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