复发性肠套叠126例临床特征分析

Analysis of clinical characteristics of 126 children with recurrent intussusception

目的分析和总结儿童复发性肠套叠的临床特征。方法回顾性研究。以2015年1月1日至2019年11月30日在浙江大学医学院附属儿童医院因“腹痛、阵发性哭闹、呕吐、血便”等症状就诊,并诊断为复发性肠套叠的126例患儿为研究对象,收集患儿临床资料,比较≤3岁组和>3岁组的临床表现,分析病理诱发点(PLP)的病因构成和年龄特点;比较有PLP组和无PLP组的临床特征,组间比较采用χ^(2)检验、Mann-Whitney U检验。结果126例患儿中男76例、女50例,年龄为2.9(1.7,5.1)岁,>1岁的患儿占87.3%(110/126),>3岁的患儿占48.4%(61/126)。临床表现大多缺乏典型的肠套叠三联征,≤3岁组阵发性哭闹的发生率明显高于>3岁组[52.3%(34/65)比24.6%(15/61),χ^(2)=10.17,P=0.001],而腹痛的发生率则明显低于>3岁组[46.1%(30/65)比75.4%(46/61),χ^(2)=11.25,P=0.001]。超声检查PLP阳性报告率17.5%(22/126),确诊率63.6%(14/22)。13例患儿行CT检查,PLP阳性报告4例,最终确诊2例。本组部分患儿经结肠镜、腹腔镜或剖腹探查手术确诊有PLP组患儿37例,无PLP组患儿89例。>3岁组PLP阳性率明显高于≤3岁组[37.7%(23/61)比21.5%(14/65),χ^(2)=3.96,P=0.046]。≤3岁组PLP病因构成主要以梅克尔憩室和幼年性息肉为主,分别占7/14、3/14,>3岁组则以淋巴瘤和幼年性息肉为主,分别占34.8%(8/23)、26.1%(6/23)。有PLP组年龄明显大于无PLP组[5.2(1.6,6.7)比2.7(1.8,4.2)岁,Z=-2.26,P=0.010],而性别比例和复发次数差异均无统计学意义(均P>0.05)。结论复发性肠套叠多见于1岁以上患儿,临床表现不具特异性。影像学检查有助于PLP的识别。复发性肠套叠患儿以特发性为主,但要警惕PLP的存在,如梅克尔憩室、淋巴瘤和幼年性息肉,必要时行结肠镜检查,并及时进行手术探查和治疗。

Objective To analyze and summarize the clinical features in children with recurrent intussusception.Methods This retrospective cohort study collected the clinical data of 126 children with recurrent intussusception who were admitted to the Children′s Hospital of Zhejiang University School of Medicine due to"abdominal pain,paroxysmal crying,vomiting,bloody stools"from January 1,2015 to November 30,2019.The clinical manifestations of recurrent intussusception between≤3 years old group and>3 years old group were compared,the etiology and age characteristics of pathologic lead points(PLP)were analyzed,and the clinical characteristics of PLP group and non-PLP group were also compared.Theχ2 test and Mann-Whitney U test were used to compare the differences between groups.Results A total of 126 children with recurrent intussusception were included,of whom 76 were males and 50 were females,with the age of 2.9(1.7,5.1)years.The proportion of children aged more than 1 year was 87.3%(110/126),and 48.4%(61/126)more than 3 years.Clinical manifestations mostly lacked the typical triad of symptoms.The percentage of paroxysmal crying in≤3 years old group was significantly higher than that in>3 years old group(52.3%(34/65)vs.24.6%(15/61),χ2=10.17,P=0.001),while the percentage of abdominal pain was significantly lower than that in the>3 years old group(46.1%(30/65)vs.75.4%(46/61),χ2=11.25,P=0.001).The rate of positive ultrasound examination was 17.5%(22/126),and 63.6%(14/22)of them were diagnosed.The positive rate of CT examination was 4/13,of which 2 cases were diagnosed.In this study,37 children were diagnosed with PLP by colonoscopy,laparoscopy or laparotomy,and 89 children were found without PLP.The positive rate of PLP in>3 years old group was significantly higher than that in≤3 years old group(37.7%(23/61)vs.21.5%(14/65),χ2=3.96,P=0.046).Meckel′s diverticulum and juvenile polyp were the main contributors of PLP in≤3 years old group,accounting for 7/14 and 3/14 respectively,while lymphoma and juvenile polyp accounted for 34.8%(8/23)and 26.1%(6/23),respectively in>3 years old group.Compared with non-PLP group,PLP group had higher age(5.2(1.6,6.7)vs.2.7(1.8,4.2)years,Z=-2.26,P=0.01).However,there were no significant differences in gender and recurrence frequency between the two groups(both P>0.05).Conclusions Recurrent intussusception is more common in children more than 1 year old,and has a wide spectrum of non-specific clinical presentations.Imaging examinations can be used to identify PLP.The most recurrent intussusception is idiopathic,but the presence of PLP should be alerted for,such as Meckel′s diverticulum,lymphoma and juvenile polyp.Colonoscopy sometimes is necessary,surgical exploration and treatment should be carried out in time.