儿童过敏性紫癜合并肠套叠临床诊治分析

Clinical diagnosis and treatment of children allergic purpura combined with intussusception

目的通过分析过敏性紫癜合并肠套叠患儿的诊治情况,了解该病的临床表现,选择合适治疗方式。方法收集该院2006年1月至2016年12月收治的45例过敏性紫癜合并肠套叠患儿,对其一般资料、临床表现、影像学检查、治疗情况等进行分析。结果 45例患儿中,男30例,女15例,皮肤紫癜45例(100.0%)、腹痛45例(100.0%)、呕吐40例(88.9%)、血便26例(57.8%)、发热13例(28.9%)、腹部包块11例(24.4%)。35例患儿皮肤紫癜先出现,2例患儿皮肤紫癜和腹部症状同时出现,8例患儿腹部症状先出现。所有患儿彩色多普勒超声检查均提示"同心圆"及"假肾征"。6例患儿直接行手术治疗,39例先行空气灌肠后再行手术治疗,其中16例成功(41.0%),23例失败(59.0%)。10例患儿术中行肠切除术,套入距离为(29±15)cm;19例患儿术中行手法复位,套入距离为(13±6)cm,二者比较,差异有统计学意义(P<0.01)。结论过敏性紫癜常见临床表现有皮肤紫癜、腹痛、呕吐、血便、发热、腹部包块等,过敏性紫癜合并肠套叠空气灌肠治疗成功率较低,手术患儿肠切除率较高。

Objective Through the analysis of intussusception diagnosis and treatment of children with allergic pur-pura merger ease, to understand the clinical manifestations of the disease, and choose appropriate treatment. Methods A total of 45 eases children with allergic pulpura combining intussusception were collected from the hospital from January 2006 to De-cember 2016. The general information, clinical manifestations, imaging examination and treatment were analyzed. Results A total of 45 eases included 30 male children, 15 female children. Among the 45 eases, skin purpura 45 eases （100.0%）, abdominal pain 45 eases （100.0%）, vomiting 40 eases （88.9%）, bloody stools 26 eases （57.8%）,fever 13 eases （28.9%）, abdominal mass 11 eases （24.4%）. 35 eases appeared skin purpura firstly, 2 eases appeared skin pul-pura and abdominal symptoms at the same time, 8 eases of children with abdominal symptoms came firstly. 6 eases children underwent surgical treatment directly, 39 eases firstly received air enema, only 16 eases （41.0%） succeeded, 23 eases （59.0%） failed and underwent surgical treatment. 10 eases received bowel resection, the average distance was （29±15）cm, and 19 eases received manual reduction, the average distance was （13±6）cm, the difference of distance was statistically significant （P〈0.01）. Conclusion Common clinical mani-festations of allergic pul-pura are skin purpura, abdominal pain, vomiting, blood, fever, abdominal mass and so on. The success rate of the patients with allergic purpura combining intussusception is lower, and the rate of enterotomy is higher.