小兒腸套疊之臨床觀察

臺大醫院小兒科自民國67年1月至74年3月7年2個月間共經歷了114例131次腸套疊之病例，回顧這些患者分別以其年齡、性別、臨床症狀、發病時間、發病原因等，加以分析。114例中，年齡最小者為21天，最大者為9歲，男孩比女孩稍多，約為1.42:1。發生年齡大部分在2歲以下(86.3%)，尤以1歲以下為多，共96次(73.3%)。新生兒病例1例，季節的差別並不明顯，但以6,7,8月較多。其中有特殊導引點者9例，佔7.9%。復發例共14例，包括復發1次者11例，復發2次者3例，復發率為12.3%。復發例中有特殊導引點者3例。臨床症狀以血便(87.8%)最常見，其中包括黏液血便(currant jelly stool) 62.6%，肛診或灌腸後血便25.2%。其次為嘔吐75.6%，煩燥不安與腹痛63.4%，腹部腫塊60.3%。四大主徵皆具備者有19.1%。種類以廻腸套入結腸型最多，佔39.7%。鋇劑灌腸復位共做了86次，52次成功，成功率60.5%。單純接受開刀者45次，原發開刀率34.4%。2例死亡，死亡之可能原因為敗血症，死亡率1.75%。本研究顯示腸套疊之早期診斷及正確之鋇劑灌腸復位可以減少併發症及開刀治療之機會，而腸套疊之復發乃屬常見，應加注意。

關鍵字

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並列摘要

A retrospective study of the clinical features and management of 114 children with intussusception is presented. All were treated in the National Taiwan University Hospital between January 1978 and March 1985. Sixty-seven were male and 47 female, with a sex ratio of 1.42/1. Their ages ranged from twenty-one days to nine years: 86.3% cases occurred before two, and 73.3% occurred before one year of age. There was one neonatal case. Although there appeared to be a greater incidence in the summer, the clustering was not marked. There were nine cases with organic leading points (79%). Fourteen cases recurred, with a recurrence rate of 12.3%. In the recurrent cases, three had organic leading points. Bloody stool was the most common symptom: 87.8% in the entire series, including spontaneous currant jelly stool and blood found on rectal examination or glycerin enema. Vomiting (75.6%), irritability (63.4%), abdominal mass (60.3%) were the other common symptoms. The four cardinal symptoms were fully developed only in 19.1%. The most common type of intussusception was the ileo-colic type (39.7%). Barium enema reduction was attempted in 86 episodes and succeeded in 52 (60.5%). Two patients died of probable sepsis, a mortality rate of 1.75%. This study shows that early diagnosis and barium enema reduction may reduce complication and the necessity of laparotomy. The recurrence of intussusception is not rare, thus special awareness of the possibility is needed.

並列關鍵字

intussusception ； barium enema ； leading point of intussusception ； recurrence of intussusception

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小兒腸套疊之臨床觀察

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