目的总结降低胰十二指肠切除术后胰空肠吻合口漏发病率的经验体会。 方法切除胰头后，将胰腺残端游离2.5～3.0 cm，利用红色石蕊试纸遇碱性胰液变蓝的特性，帮助寻找胰腺断面被横断的小导管，丝线贯穿缝扎。将空肠袢断端2.0～2.5 cm浆肌层剥除后施行套叠式胰空肠端端吻合，距浆肌层游离缘1.0～1.5 cm 处空肠上下壁各缝1针固定，最后用纤维蛋白胶封闭吻合口。结果47例患者中无一例发生胰空肠吻合口漏。结论该法操作较简便，适用于胰腺残端各种情况的处理。
Objective To investigate the value of the multi-detector row spiral CT (MDCT) and 3-dimensional reconstruction technique for adult intussusception. Methods Twenty-one patients with surgically and clinical following-up confirmed intussusception were retrospectively included into this study. Three patients had plain MDCT scan, 18 received contrast enhanced MDCT scan. The original images were reconstructed with multi-planar reconstruction (MPR) technique and all the images of 21 patients were divided into original image group and original image add MPR image group. Two abdominal radiologists analyzed the MDCT imaging and recorded respectively the accuracy rate and the confidence index of the doctor about following indexes: whether or not having intussusception, the location of intussusception, finding reason caused intussusception, whether or not having bowel wall ischemia and whether or not having bowel obstruction. The accuracy rate and the confidence index of the doctor were compared using a SPSS statistics software. Results The accuracy rates about above indexes between original image group and original image add MPR image group were 90.5% (19/21) vs. 100% (21/21), 81.0% (17/21) vs. 95.2% (20/21), 85.7% (18/21) vs. 90.5% (19/21), 90.9% (10/11) vs. 90.9% (10/11) and 100% (11/11) vs. 100% (11/11) respectively, and there was no significant difference between original image group and original image add MPR image group (Pgt;0.05). For following indexes: whether or not having intussusception, the location of intussusception, finding reason caused intussusception, the confidence index of the doctor between original image add MPR image group and original image group had significant difference (5.00 vs. 4.24, 4.76 vs. 4.29, 4.29 vs. 3.71), and the confidence index of the doctor of original image add MPR image group exceeded that of original image group (Plt;0.05). Conclusions MDCT plays a valuable role in diagnosis and location of intussusception, finding the reason caused intussusception and evaluation the hemodynamic impairment of being involved in bowel wall. Compared to simple axial image, axial image combine 3-dimensional reconstructed image can increase the diagnostic confidence of the doctor.
To assist grassroots sonographers in accurately and rapidly detecting intussusception lesions from children's abdominal ultrasound images, this paper proposes an improved YOLOv8n children's intussusception detection algorithm, called EMC-YOLOv8n. Firstly, the EfficientViT network with a cascaded group attention module was used as the backbone network to enhance the speed of target detection. Secondly, the improved C2fMBC module was used to replace the C2f module in the neck network to reduce network complexity, and the coordinate attention (CA) module was introduced after each C2fMBC module to enhance attention to positional information. Finally, experiments were conducted on the self-built dataset of intussusception in children. The results showed that the recall rate, average detection accuracy (mAP@0.5) and precision of the EMC-YOLOv8n algorithm improved by 3.9%, 2.1% and 0.9%, respectively, compared to the baseline algorithm. Despite slightly increased network parameters and computational load, significant improvements in detection accuracy enable efficient completion of detection tasks, demonstrating substantial economic and social value.
目的 探讨婴幼儿肠套叠空气灌肠复位的指征、操作方法和中转手术的时机。方法 对我院1993～1998年5年间在X线透视下行空气灌肠复位治疗的婴幼儿肠套叠162例进行回顾性分析。结果 复位成功者148例，成功率为91.4%，其余14例中转手术治疗。随访1～5年，预后良好。结论 空气灌肠复位是婴幼儿肠套叠早期治疗的首选 方法，应谨慎把握其适应证，熟练掌握操作方法，不应轻易放弃而过早手术。但对病程较长，伴有腹膜炎体征或复位失败者，须及时手术治疗。
目的 比较电脑遥控灌肠整复仪与简易空气灌肠器对小儿肠套叠的整复效果，探讨更有效安全的空气灌肠设备。 方法 2002年11月－2011年11月对确诊的425例小儿肠套叠应用空气灌肠整复，其中198例采用简易空气灌肠器整复，227例用电脑遥控灌肠整复仪进行空气灌肠整复，并对不同病程时间、套叠部位与两种空气灌肠设备整复结果进行回顾性分析。 结果 198例患儿采用简易空气灌肠器整复成功率为71.2%，227例患儿采用电脑遥控灌肠整复仪的方式整复成功率为83.3%，后者成功率明显高于前者（P＜0.005），尤其是病程时间在24 h内，套叠部位位于升结肠或横结肠的后者整复成功率更高（P＜0.05）。 结论 电脑遥控灌肠整复仪比简易空气灌肠器更有效、安全。脉冲式空气灌肠能减轻套叠部位的痉挛与水肿，提高肠套叠的整复成功率。
目的 总结成人大肠套叠治疗经验。方法 回顾性分析我院1969～1998年收治的83例成人大肠套叠患者的临床资料。结果 经钡灌肠复位6例，手术治疗77例。肿瘤性大肠套叠60.2%，其中恶性肿瘤性套叠占64.0%。恶性肿瘤套叠手术切除5年生存率43.8%。结论 对成人大肠套叠治疗首选手术切除，慎用手术复位，不主张钡灌肠复位。
ObjectiveTo study the clinical significance of color Doppler ultrasound in the diagnosis of intussusception in children. MethodsWe retrospectively analyzed the color Doppler ultrasound results of 150 children with intussusception confirmed by X-ray air enema and surgery between January 2010 and December 2012. ResultsThe 150 children included 18 cases of necrosis, and 132 cases of simple edema; there were 122 cases of ileocecal intussusception, 22 cases of colon, and 6 of small intestine. Surgical treatment was performed for 30 cases, and 120 cases were treated with X-ray air enema reduction. Ultrasonic diagnosis was correct in 144 cases with an accurate rate of 96.0%; 6 cases were misdiagnosed, and misdiagnosis rate was 4.0%. ConclusionUltrasound in the diagnosis of children intussusception is simple, rapid, non-invasive, with no side-effects of radiation exposure, and selection of this method clinically has a very important significance.
To analyze the causes of failure to reduce acute infantile intussusception with gas enema. 441 cases of acute infantile intussusception in our hospital who failed to be reduced with gas-enema, and underwent the operative therapy were analyzed. Result: 92 cases (20.9%) were intestinal necrosis, 184 cases (41.7%) double intussusception, 27 cases (6.1%) organic pathological changes and 8 cases (1.8%) intestinal perforation caused by gas-enema reduction. All the cases had a successful recovery after surgery. Conclusion: The main causes of failure to reduction with gas-enema were as follows: ①double intussusception, ②intestinal necrosis, ③late for visiting a doctor, ④organic pathological changes, ⑤perforation (in the process of gas-enema reduction). The importance of early diagnosis is emphasized.