新生兒腸套疊文獻之回顧及一病例報告

新生兒腸套疊是一種非常罕見且具有高度危險性之疾病，著者等報告一位出生3天而由腸息肉引起之腸套疊病例，並參考文獻做有系統的分析及討論。由收集到之文獻及資料顯示，新生兒腸套疊僅有56例，它在腸套疊中之發生率為0~2.17%，年齡最小者為出生三分鐘卽告死亡者，新生兒腸套疊之症狀並不明顯，有時只有血便(80.6%)－常呈葡萄果醬樣血便，嘔吐(67.7%)兩種症狀，腹痛及腫瘤觸知率則偏低，有時因僅有血便而被誤診爲新生兒出血性疾病，而腸套疊發和於小腸(entero-enteric type)之百分率相當高，有50%，尤其是空腸－空腸型(jejuno-jejunal type)佔29.4%，鋇鹽大腸灌腸造影術不易發現，診斷相當困難且不易以鋇鹽高壓灌腸整復，往往由於診治之延誤，因脫水、腸壞死、腸穿孔、腹膜炎、大量出血而造成相當高之死亡率(57.1%)，且新生兒之腸壁較薄又脆弱易生特殊之局部病灶，故治療方法仍以手術爲首要之選擇。

關鍵字

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並列摘要

Intussusception is a rare and of high risk condition in the neonatal period. A case of 3-day-old newborn is presented here with a review of the literature. We have been able to find 56 cases of neonatal intussusception from the literature, with an incidence of 0-2.17% among 7,135 cases of intussusception. The youngest was an autopsy case just 3 minutes after birth. It has a different mode of presentation from that in older infants. Bloody stool (80.6%) and vomiting (67.7%) especially with bile stained vomitus are the most common symptoms recorded. A mass is not often palpable and abdominal pain is rarely detected, even if it is present. When bloody stool is the presenting symptom, an erroneous diagnosis of hemorrhagic disease of newborn is sometimes made. There was a high incidence of entero-enteric type (50%) in this study especially jejuno-jejunal type (29.4%) which was almost irreducible and difficult to find in barium enema. The correct diagnosis was often delayed due to limitation of barium enema and obscurity of symptoms and signs. That may be complicated with dehydration, gangrenous change of the bowel, intestinal perforation, peritonitis, massive hemorrhage resulting in high mortality (57.1%). Once diagnosis is considered probable, surgical operation should be the first choice because of the special leading points and the high incidence of irreducibility.

並列關鍵字

neonatal intussusception ； leading points ； resection and anastomosis

國際替代計量

新生兒腸套疊文獻之回顧及一病例報告

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