儿童复发性肠套叠的临床特点及危险因素分析:单中心回顾性研究

Clinical characteristics and risk factors for recurrent intussusception in children:A single-center retrospective study

目的回顾性分析肠套叠的临床特点及复发危险因素,提高儿童复发性肠套叠的诊治水平。方法以2015年1月至2019年12月湖南省儿童医院诊断为肠套叠的6874例患儿为研究对象,根据有无复发分为复发组和无复发组;根据首次肠套叠发生年龄,又分为≤1岁组、1~2岁组(含2岁)、2~3岁组(含3岁)、3~4岁组(含4岁)、4~5岁组(含5岁)、>5岁组。总结复发性肠套叠的临床特点,采用单因素分析并比较两组间各项临床特征的差异,将单因素分析中有统计学意义的变量进一步纳入多因素Logistic分析,探讨肠套叠复发的相关风险因素。结果6874例患儿中,无复发组5498例,复发组1376例,总复发率为20.0%(1376/6874)。单因素分析结果显示,两组间年龄、临床症状(呕吐、腹痛、血便/果酱样便)、套头位置、腹部包块、合并继发性病理因素(pathological lead points,PLPs)的差异有统计学意义(P<0.05);多因素Logistic分析结果显示:年龄(OR=4.431,95%CI:1.549~5.167,P<0.001)、呕吐(OR=0.259,95%CI:0.278~0.691,P<0.001)、血便/果酱样便(OR=0.498,95%CI:0.325~0.802,P=0.003)、合并PLPs(OR=3.378,95%CI:2.851~12.071,P<0.001)是肠套叠复发的相关因素。≤1岁组复发率最低(15.3%,290/1896),手术率最高(20.7%,394/1896);>5岁组合并PLPs的人数比例最高(9.4%,31/330)。结论年龄越小的肠套叠患儿复发率越低;随年龄增长,肠套叠患儿合并PLPs的比例增加;年龄、合并PLPs、存在呕吐以及血便/果酱样便症状与肠套叠复发相关。

Objective To explore the clinical characteristics and recurrence risk factors of intussusception to boost the diagnosis and treatment of recurrent intussusception in children.Methods From January 2015 to December 2019,clinical data were retrospectively reviewed for 6874 children of intussusceptions.They were divided into two groups of recurrent intussusceptions(n=1376)and non-recurrent intussusceptions(n=5498).According to the age of initial intussusception,they were assigned into 6 age groups:≤1 year old,1-2 years old,2-3 years old,3-4 years old,4-5 years old and>5 years old.Clinical characteristics of recurrent intussusception were summarized,univariate analysis was performed and the inter-group differences were compared.Variables with significant differences(P<0.05)were further included into multivariate Logistic analysis for exploring the risk factors correlated with recurrent intussusception.Results The overall recurrence rate was 20.0%(1376/6874).Univariate analysis hinted at statistically significant inter-group differences in age,clinical symptoms(vomiting,abdominal pain,bloody stool/jam stool),head position,abdominal mass and complicated secondary pathological lead points(PLPs)(P<0.05).Multivariate Logistic analysis indicated that age(OR=4.431,OR value 95%CI:1.549-5.167,P<0.001),vomiting(OR=0.259,OR 95%CI:0.278-0.691,P<0.001),blood stool/jam stool(OR=0.498,OR 95%CI:0.325-0.802,P=0.003)and combined PLPs(OR=3.378,95%CI:2.851-12.071,P<0.001)were the correlated factors of intussusception recurrence.The recurrence rate within 1 year old was the lowest(15.3%,290/1896),operation rate was the highest(20.7%,394/1896)and PLPs cases were the highest in group over 5 years old(9.4%,31/330).Conclusion The younger age,the lower recurrence rate of intussusception.With advancing age,the proportion of children with PLPs of intussusception increased.Age,PLPs,vomiting and symptoms of bloody/jam stool are associated with intussusception recurrence.