单中心儿童继发性肠套叠的临床特点总结

Clinical characteristics of pediatric secondary intussusception at a single center

目的 探讨儿童继发性肠套叠的临床特点，以提高临床诊疗水平。方法 回顾2014年1月至2016年12月收治的98例继发性肠套叠患儿的临床资料，分析其临床症状、年龄分布、病史时间（从出现腹痛、呕吐、血便等临床相关症状到诊断肠套叠的时间）及发生肠管坏死相关因素。本组男69例，女29例；中位年龄5岁4个月。继发于梅克尔憩室27例，淋巴瘤和P-J息肉均为17例，幼年性息肉15例，紫癜13例，肠重复畸形4例，其他5例。有腹痛表现85例，呕吐65例，血便25例，肠管坏死23例。结果 本组大于3岁者77例，小于1岁者7例。继发于淋巴瘤及紫癜者，均大于3岁。继发于淋巴瘤、紫癜和P-J息肉患儿中大于5岁者所占比例分别为82.4%（14/17）、84.6%（11/13）和82.4%（14/17）。继发于梅克尔憩室患儿病史时间小于48 h者占74.1%（20/27）。继发于息肉（幼年性息肉和P-J息肉）及淋巴瘤患儿病史时间大于48 h者占比较高分别为65.6%（21/32）和82.4%（14/17）。病史时间在24～48 h者和继发于紫癜者的肠管坏死占比最高，分别为70.6%（12/17）和46.2%（6/13），而便血及电解质紊乱对肠套叠发生肠管坏死的指示意义并不大。结论 继发性肠套叠的继发因素以梅克尔憩室和息肉为主。随年龄增大，息肉、淋巴瘤及紫癜继发的可能性越大。紫癜继发者最易发生肠管坏死，需及早手术。

Objective To summarize the clinical features of pediatric secondary intussusception.Methods Retrospective analyses were performed for the clinical data of 98 hospitalized children with secondary intussusceptions from January 2014 to December 2016.Results The causes of secondary intussusception were Meckel’s diverticulum （n=27）, lymphoma （n=17）, Peutz-Jeghers syndrome polyp （n=17）, juvenile polyp （n=15）, allergic purpura （n=13）, intestinal duplication （n=4） and other causes （n=5）. Clinical symptoms included abdominal pain （n=85）, vomiting （n=65） and hematochezia （n=25）. Twenty-three patients were intra-operatively diagnosed as intestinal necrosis. The median onset age was 64（6-169） months. There were 77/98 patients aged over 3 years and 7/98 patients aged under 1 year. All patients of lymphoma and allergic purpura were aged over 3 years. Most patients of lymphoma, allergic purpura and Peutz-Jeghers syndrome polyp were aged over 5 years with the ratios of 14/17, 11/13 and 14/17 respectively. Duration between onset and admission were shorter in Meckel’s diverticulum patients, with 20/27 within 48 h; while in polyp （including juvenile and Peutz-Jeghers syndrome） and lymphoma were longer, with 21/32 and 14/17 over 48 hours respectively. Intestinal necrosis occurred mostly in patients with a clinical course of 24-48 hours （12/17） and allergic purpura co-existed with intestinal necrosis （6/13）. Hematochezia and electrolyte disorder indicated no extent of intestinal necrosis.Conclusions Two major causes of secondary intestinal intussusception are Meckel’s diverticulum and polyp. With advancing age, secondary factors include polyps, lymphoma and purpura. Purpura secondary intussusception is the most susceptible to intestinal necrosis and early surgery is required.