以肠套叠为首发表现的小儿肠道疾病临床分析

Clinical analysis of primary intestinal diseases in children with intussusception as the first presentation

目的探讨以肠套叠为首发表现的小儿原发性肠道疾病的临床特点,提高肠套叠的临床诊治水平。方法回顾性分析2015年1月至2017年2月收治的18例以肠套叠为首发表现的患儿,临床表现及诊治特点。结果18例患儿术中均行肠切除肠吻合术,术后病理检查证实:升结肠非霍奇金淋巴瘤,B系(伯基特淋巴瘤)1例,回盲部非霍奇金淋巴瘤,B系(伯基特淋巴瘤)1例;回肠黏膜相关淋巴组织淋巴瘤(MALT淋巴瘤)3例;回盲部幼年性息肉1例,回肠幼年性息肉1例;黑斑息肉综合征型错构瘤性息肉(空肠)1例,黑斑息肉综合征型错构瘤性息肉(回肠)1例;回盲部肠重复畸形2例,回肠肠重复畸形5例;梅克尔憩室(回肠)2例。结论对于非典型发病年龄、病程较长、反复发作的肠套叠,应注意有无原发性肠道疾病继发肠套叠的可能性,条件允许时首选超声引导下盐水灌肠整复,该方法经济、安全,同时能发现部分肠道器质性病变,为进一步相关检查和手术探查提供依据,是基层医院无空气灌肠机的有效替代。对反复发作的肠套叠,需高度怀疑器质性病变的存在,手术探查很有必要,术中需仔细检查肠腔内病变,以免遗漏病变。

Objective To explore the clinical features of pediatric primary intestinal diseases with intussusception as the first presentation to improve the clinical diagnosis and treatment of intussusception. MethodsRetrospective review was performed for 8 children with intussusception as the first manifestation from January 2015 to February 2017 and their clinical manifestations, diagnosis and treatment characteristics were analyzed. Results Intestinal resection and anastomosis were performed. And postoperative pathological examinations revealed ascending colon non-Hodgkin's lymphoma B line (Burkitt's lymphoma)(n=1), ileocecal non-Hodgkin's lymphoma B line (Burkitt's lymphoma)(n=1), ileal mucosa-associated lymphoid tissue lymphoma (MALT lymphoma)(n=3), ileocecal juvenile polyps (n=1), ileal juvenile polyps (n=1), hemopsy syndrome hamartoma polyps (jejunum)(n=1), hemopsy syndrome hamartoma polyps (ileum)(n=1), ileocecal duplication of intestine (n=2), ileal duplication of intestine (n=5) and Meckel’s diverticulum (ileum)(n=2). Conclusions Greater attention should be paid to the possibility of secondary intestinal intussusception in children of primary intestinal disease concerning atypical age of onset, longer duration and recurrence. Whenever conditions permit, ultrasound-guided saline enema restoration is preferred. Both economical and safe, it may detect some intestinal organic disease to provide rationales for further examinations and surgical exploration. It should be an effective substitute for air enema machine at grass-roots hospitals. As for recurrent intussusception, it is necessary to highly suspect the existence of organic diseases. Surgical exploration should be performed for intestinal lesions so as to avoid a misdiagnosis.