复发性肠套叠的临床特点及治疗

Clinical Characteristic and Treatment of Recurrent Intussusception

目的分析小儿复发性肠套叠的临床特点及治疗。方法回顾性分析2002年1月-2010年12月本院3 730例肠套叠患儿的临床资料,其中复发性肠套叠395例。统计的内容包括一般情况、放射学表现和治疗结果。对于复发病例行进一步评估,并将不同治疗方法的复发率进行比较,分析不同治疗方法和复发之间的关系。应用SPSS 16.0软件进行数据处理。结果 3 730例肠套叠患儿中空气灌肠治疗3 729例,成功整复3 234例(86.7%),复发375例(11.6%)。空气灌肠治疗失败后行手术治疗495例,其中单纯手法整复474例,术后20例复发(4.2%);行肠切除21例(11.4%),其中3例存在基础病变:2例存在小肠憩室,1例存在肠系膜囊肿。复发性肠套叠患儿395例,共发生587次肠套叠,复发率为10.6%(395/3 730例)。首次发生肠套叠2岁内患儿占84.0%(332/395例)。复发时间间隔1 d～8 a,54.9%的复发性肠套叠发生在6个月内。空气灌肠治疗395例复发性肠套叠,整复成功345例(87.3%),与空气灌肠治疗初次肠套叠的成功率比较无统计学差异(χ2=0.044,P>0.05)。结论复发性肠套叠大多数是非特异性的,空气灌肠是首选治疗方式。开腹手术适用于空气灌肠整复失败、疑有病理诱因或多次复发的患儿。

Objective To analyze the clinical features and treatment of recurrent intussusception in children. Methods A retrospective study from Jan.2002 to Dec.2010,of 3 730 cases of intussusception,who were admitted to Wuhan Medical Health Center for Women and Children,including 395 cases of recurrent intussusception.Statistics included general condition,radiological features,and therapeutic outcome.Recurrence rate were compared between different treatment methods.SPSS 16.0 software was used to analyze the data. Results Among all the 3 730 cases of intussusception,the air enema was used in 3 729 cases,in which 3 234 cases（86.7%） achieved successful restoration and 375 cases（11.6%） were recurrent.Among 495 cases who underwent surgery after air enema treatment failed,474 cases were applied with manipulative reduction,of which 20 cases（4.2%） were recurrent and 21 cases（11.4%） received bowel resection with no recurrence.In 3 cases,a lead point was found that 1 case was mesenteric cyst,and 2 cases were small intestine diverticulum.There were 395 cases of recurrent intussusception which recurred 587 times,and the recurrence rate was 10.6%（395/3 730 cases）.First intussusception which occurred before 2 years old,accounted for 84.0%（332/395 cases）.Recurrence interval ranged from 1 day to 8 years.Fifty-four point nine percent of recurrent intussusception occurred within 6 months.Three hundred and forty-five cases achieved successful restoration（87.3%） by means of air enema.There was no significant difference of the achievement ratio by air enema in treating recurrent intussusception and initial intussusception（χ2=0.044,P〈0.05）. Conclusions The majority of recurrent intussusception is non-specific.Air enema is the preferential method for recurrent intussusception.Surgical reduction can be reserved for cases of failed air enema reduction,existence of pathological lead point and repeated recurrence.