儿童继发性肠套叠临床特点分析

Clinical characteristics of secondary intussusception in children

目的探讨大于3岁儿童继发性肠套叠的临床特点和发病原因，提高儿童肠套叠的诊治水平。方法回顾性总结重庆医科大学附属儿童医院2001～2011年收治的大于3岁儿童继发性肠套叠，分析其临床表现、发病原因及诊疗情况。结果82例患儿腹痛80例，呕吐56例，血便34例，腹部扪及包块31例。82例中过敏性紫癜48例（58．8％），肠息肉9例（11．0％）、梅克尔憩室7例（8．5％）、肿瘤5例（6．1％），其他13例。63例行空气灌肠复位治疗，28例成功，平均压力7．7kPa。54例手术治疗，术中见回结型18例，回回型11例，回盲型8例，空空型4例，回回结型4例，结结型4例，自动复位5例；肠坏死14例。结论大于3岁儿童继发性肠套叠比例随年龄增加而增加，过敏性紫癜是主要继发因素。病程大于3d或者反复发生肠套叠者需警惕继发性肠套叠；病程超过14d需警惕肠道肿瘤。儿童肠套叠继发于过敏性紫殿时，空气灌肠是安全、有效的治疗方法。肠套叠由器质性病变引起时，手术去除病变是主要治疗手段。

Objective To explore the clinical characteristics of secondary intussusception in chil- dren 〉3 years old and to improve the diagnostic capacity. Methods We retrospectively reviewed in- tussusception cases in children 〉3 years old admitted during 2001-2011. Clinical manifestations, etiol- ogies and clinical courses were studied. Results Eighty-two confirmed cases were collected. Eighty cases manifested with abdominal pain, 56 cases with vomiting, 34 cases with hematochezia, and 31 ca- ses with abdominal mass. Forty-eight cases （58.8%）were caused by Henoch-Schonlein purpura, 9 cases （11.0%） by intestinal polyp, 7 cases （8. 5%） by Meckel＇s diverticulum, 5 cases （6. 1%） by tumor,and 13 cases by others. Air enema was performed in 63 cases with 28 cases successful. Surgery was performed on 54 cases. Ileocolic intussusception were seen in 18 cases, ileoileal in 11 cases, ileo- cecal in 8 cases, ileoileocolic in 4 cases, jejunojejunal in 4 cases, colocolic in 4 cases, and spontaneous reduction in 5 cases. Intestinal necrosis was found in 14 cases. Conclusions Secondary intussusception is hard to diagnose in children over 3 years old. Intussuscepiton lasting more than 3 days or repeated intussusception should have secondary causes investigated. Although air enema is a safe and effective treatment of secondary intussuception, surgery remains the main treatment.