小兒腸套疊的臨床特徵和處理策略

Characteristics and strategies for the intussusceptions in children

目的探討小兒腸套疊的臨床特徵和處理方法。方法回顧性對照研究澳門一間綜合醫院,32個月期間,小腸型和回結型腸套疊的臨床表現和超聲診斷的特徵及鑑別,處理策略和隨訪結果。結果177例確診腸套疊,小腸型103例(58.2%),回結型74例(41.8%),小腸型發生年齡大於回結型(3.4歲:2.5歲,t=3.598),腹痛、嘔吐和發熱為主要臨床症狀,但是兩組沒有統計學差異(P>0.05)。回結型腸套疊包塊的直徑和長度均大於小腸型(長徑3.17cm:1.85cm,z=9.657,P=0.000;短徑2.79cm:1.57cm,z=10.037,P=0.000;套疊包塊長4.74cm:2.83cm,z=8.416,P=0.000)。回結型多伴有腹腔積液,腸系膜淋巴結腫大,小腸型腸蠕動活躍,P<0.01。同時多個套疊包塊以小腸型組多於回結型組,19.4%:5.4%,χ^(2)=7.213,P=0.007。手術治療回結型組12例(16.2%),小腸組4例(3.9%),χ^(2)=7.966,P=0.005。隨訪2個月到32個月,患兒生長發育正常。結論在澳門地區小兒腸套疊小腸型多於回結型,小腸型套疊可以同時多發並常見檢查中解套。小腸型是一過性多數可以自行解套,只需觀察不需要特別處理,而回結型需要急診復位治療。

Objective To study clinical characteristics and strategies for the small bowel intussusceptions in children.Methods The clinical manifestations,ultrasonographic images and differential diagnosis,management strategies and follow-up results of the small bowel and ileocolic intussusceptions in children have retrospectively analyzed at a general hospital in Macao for 32 months.Statistics data accessed with SPSS 11.5 statistics software.Results 177 cases confirmed diagnosis of intussusceptions,in which small bowel type was 58.2%and ileocolic type was 41.8%(n=103:74),had the dominating symptoms of abdominal pain,vomiting and fever,but no statistically significant differences in both groups(P>0.05).The patient age of the small bowel group was older than those of the ileocolic(3.4y:2.5y,t=3.598,P=0.000).The diameter and length of intussusceptive masses in the ileocolic were larger than those in small bowel(Long diameter 3.17cm:1.85cm,z=9.657,P=0.000.Short diameter 2.79cm:1.57cm,z=10.037,P=0.000.Length 4.74cm:2.83cm,z=8.416,P=0.000).The abdominal collections and enlarged mesenteric lymph nodes in the ileocolic group were more presented than in the small bowel group,but the peristalsis in the small bowel group was more active than in the ileocolic(p<0.01).More multiple masses were found in the small bowel group than in the ileocolic group(19.4%:5.4%,χ^(2)=7.213,P=0.007).Surgery of the ileocolic group was 16.2%(12/74),and 3.9%(4/103)of the small bowel group(χ^(2)=7.966,P=0.005).Following up the patients from 2 months to 32 months,all patients normally grew and developed.Conclusion Small bowel intussusceptions are higher than the ileocolic in the Macao of China.The patient's age in the small bowel group is older than that of the ileocolic.The diameter and length of intussusceptive masses in the small bowel are shorter than in the ileocolic.The peristalsis is more active,but the abdominal collections and enlarged lymph nodes are less presented in the small bowel group than in the ileocolic.More multiple masses are found in the small bowel group than in the ileocolic.The small bowel intussusceptions are transient and can be reduced spontaneously.It needs no further management but a conservative observation.The ileocolic intussusceptions need urgent management for reduction.