超声引导下小儿原发性肠套叠水压灌肠治疗成功后复套发生的危险因素分析

Risk factors analysis of recurrent primary intussusception in children of hydrostatic reduction guided by ultrasonography

目的探讨超声引导下小儿原发性肠套叠水压灌肠治疗成功后复套发生的危险因素。方法回顾性分析我院收治的50例原发性肠套叠患儿的临床资料和声像图,分别收集临床资料(性别、年龄、有无呕吐或血便)及超声特征(肠套位置、肠套叠"同心圆"最大径、套入肠壁有无血流信号、有无腹腔积液、有无肿大淋巴结)。通过单因素分析筛选出超声引导下水压灌肠治疗成功后复套发生的危险因素,应用二分类Logistic回归分析预测复套发生的独立危险因素。绘制受试者工作特征(ROC)曲线分析各相关因素预判复套发生的截断值及曲线下面积。结果单因素分析显示,肠套叠"同心圆"最大径、血便、腹腔积液及套入肠管壁无血流信号是复套发生的危险因素(均P<0.05);Logistic多因素回归分析显示,肠套叠"同心圆"最大径、血便、腹腔积液、套入肠管壁无血流信号均是预测复套发生的独立危险因素(OR=5.88、4.20、4.12、3.55);其中肠套叠"同心圆"预测复套诊断效能最高,其评估复套发生的截断值为35 mm,ROC曲线下面积为0.97。结论超声引导下小儿原发性肠套叠水压灌肠治疗成功后复套发生的主要危险因素分别为肠套叠"同心圆"最大径≥35 mm、出现血便、腹腔积液及套入肠管壁无血流信号。

ObjectiveTo explore the risk factors of recurrent primary intussusception in children of hydrostaticreduction guided by ultrasonography.MethodsThe clinical data(gender,age,vomiting and bloody stool)and ultrasound images(intussusception location,maximum diameter of intussusception"concentric circle",blood flow signal of intestinal wall,seroperitoneum and enlarged lymph nodes)of 50 primary intussusception in children were retrospectively analyzed. The riskfactors of recurrent intussusception were screened out by the univariate analysis,and binary Logistic regression equation wasused to analyze the risk factors.The area under the curve and the cut-off value of each factor were calculated by the receiveroperating characteristic(ROC) curve.ResultsUnivariate analysis showed that the maximum diameter of intussusception"concentric circle",blood stool,seroperitoneum and no blood flow signal of the intestinal wall were the risk factors for theoccurrence of recurrent intussusception(all P<0.05). Logistic regression analysis revealed that maximum diameter ofintussusception"concentric circle",bloody stool,seroperitoneum,no blood flow signal of intestinal wall were independent riskfactors for the occurrence of intussusception(OR=5.88,4.20,4.12,3.55). The cut-off value of maximum diameter ofintussusception"concentric circle"was 35 mm,and the area under ROC curve was 0.97,which had the highest predictiveefficacy.ConclusionThe maximum diameter of intussusception"concentric circle"≥35 mm,blood stool,seroperitoneum andno blood flow signal of intestinal wall are the important risk factors for recurrent primary intussusception in children ofhydrostatic reduction guided by ultrasonography.