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首页> 外文期刊>AJR: American Journal of Roentgenology : Including Diagnostic Radiology, Radiation Oncology, Nuclear Medicine, Ultrasonography and Related Basic Sciences >Intussusception revisited: Is immediate on-site surgeon availability at the time of reduction necessary?
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Intussusception revisited: Is immediate on-site surgeon availability at the time of reduction necessary?

机译：肠套公布重新审视：在减少时，是立即现场外科医生可用性吗？

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OBJECTIVE. The American College of Radiology recommends that fluoroscopically guided intussusception reduction be performed with a surgeon readily available. At many institutions, this may not be feasible. The purpose of this study was to assess the utilization of immediate surgical services at the time of radiologic intussusception reduction. MATERIALS AND METHODS. All radiologic intussusception reductions at a tertiary care children's hospital from November 2007 through August 2012 were reviewed to determine method, complications, clinical status of the child, and time between unsuccessful reduction and operative intervention. RESULTS. Among 433 patients with intussusception referred for fluoroscopic reduction, 86.1% (n = 373) had successful reductions, and 13.9% (n = 60) had unsuccessful reductions. Five perforations represented 8.3% (5/60) of the unsuccessful and 1.2% (5/433) of the total reduction attempts. Six patients' conditions became hemodynamically unstable during attempted reduction (four perforations, two unsuccessful reductions without perforation), representing 10% (6/60) of unsuccessful and 1.4% (6/433) of total reduction attempts. Percutaneous needle decompression and cardiopulmonary resuscitation restored hemodynamic stability in all cases. The mean time to surgery after perforation was 1.3 hours, after unsuccessful reduction complicated by hemodynamic instability was 2.2 hours, and after unsuccessful radiologic reduction without complication was 4.3 hours. CONCLUSION. In this series, complications requiring immediate medical or surgical attention were rare, occurring in 1.6% of cases (five bowel perforations, two cases of hemodynamic instability without perforation). On-site surgeon presence may not be necessary at the time of radiologically guided reduction attempts provided that the attending physician is facile with percutaneous needle decompression and management of hemodynamic instability and that ultimate surgical care can be arranged expeditiously.
机译：客观的。美国放射学院建议在易于使用的外科医生进行荧光透视引导的肠套叠。在许多机构，这可能是不可行的。本研究的目的是评估放射学肠肠溶减少时立即外科服务的利用。材料和方法。从2007年11月到2012年8月到2012年8月的所有放射科学肠套密封减少到2012年8月到2012年8月，以确定对儿童的方法，并发症，临床状况以及不成功减少和手术干预之间的时间。结果。在433例肠胃型肠道术患者中，86.1％（n = 373）成功减少，13.9％（n = 60）的减少不成功。五种穿孔，代表了8.3％（5/60）的不成功，1.2％（5/433）的总减少尝试。六名患者的病症在尝试减少时变得血流动力学不稳定（四个穿孔，两次没有穿孔的不成功），代表10％（6/60）的不成功和1.4％（6/433）的总减少尝试。经皮针减压和心肺复苏在所有情况下恢复血液动力学稳定性。穿孔后的平均手术时间为1.3小时，通过血液动力学不稳定复杂化为2.2小时，并且在不成功的放射生理学减少后没有并发症，为4.3小时。结论。在本系列中，需要即时医疗或手术注意的并发症是罕见的，在1.6％的情况下发生（五种肠道穿孔，两种血液动力学不稳定性没有穿孔的情况）。在放射学前的减少尝试时可能不需要现场外科医生存在，条件是，参加医生具有经皮针减压和血流动力学不稳定的管理，并且可以迅速安排最终的手术护理。

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