3岁以上儿童肠套叠特点初探

Clinical Characteristics of Intussusception in Children Aged Three or More

目的 探讨年龄≥ 3岁儿童肠套叠临床表现、病因及治疗等方面的特点。方法 总结该院 1993年 1月～ 2 0 0 2年 12月 10年间收住院的小儿肠套叠 10 0 5例 ,通过与年龄 3岁以内患儿肠套叠的比较探讨前者在临床表现、病因及治疗方案等方面的特点。结果 10 0 5例小儿肠套叠中 ,年龄≥ 3岁患儿 6 8例(6 .77% ) ,男女比例 2 .8∶1。发病时多没有典型临床表现 ,与年龄在 3岁以内患儿相比 ,腹痛 (6 6 .2 %∶89.9% ) ,呕吐 (5 4 .4 %∶90 .9% )及便血 (4 .4 %∶82 .0 % )的比例均显著低于后者 (P <0 .0 5 )。治疗方面 ,两组患儿需接受开腹手术的比例无显著性差异 (P >0 .0 5 )。术中发现器质性病变比例 (38.7%∶4 .4 % )及接受病变肠切除手术比例 (4 8.4 %∶14 .2 % )明显高于后者 (P <0 .0 5 )。其中器质性病因主要包括腹腔肿瘤 (16 .1% ,5 /31) ,息肉 (9.7% ,3/31) ,憩室 (9.7% % ,3/31) ,囊肿 (1.5 % ,1/31)等。结论 年龄≥ 3岁儿童肠套叠缺乏婴幼儿肠套叠典型的临床表现 ;病因多涉及腹腔内器质性病变尤其是肿瘤等 ;肠部分切除手术在该组患儿的治疗中占有重要比例。

Objective: To investigate the characteristics of clinical manifestations, etiology and treatment of intussusception in children aged three or more. Methods: One thousand and five children with intussusception hospitanized from 1993 to 2002 were divided into two groups: group A(aged ≥3 years) and group B(aged <3 years). The clinical manifestations, etiology and treatment were compared between the two groups.Results:Among all the patients, 6.77% (68/1005) were aged three or more, the ratio of boys to girls was 2.8:1. Typical clinical manifestations were less common in group A compared with group B and the incidence of abdominal pain (66.2% vs 89.9%), vomiting (54. 4% vs 90.9%) and bloody stool (4.4% vs 82.0%) was significantly lower in group A (P<0.05) . As for the treatment, there was no significant difference of the ratio of the patients for whom the abdominal operation was necessary between the two groups (P>0.05). The incidence of organic diseases found in the operation and the ratio of patients undertaking enterocolectomy were much higher in group A than that in group B (38.7% vs 4.4% , P<0.05; 48.4% vs 14.2%, P<0.05, respectively) . Abdominal tumors ( 16.1%, 5/31 ), polyps (9.7%, 3/31 ), diverticula (9.7%%, 3/31 ) and cystis (1.5%, 1/31 )were the main causes of the organic diseases.Conclusions:The typical clinical manifestations of intussusception were absent in the children aged three or more . Organic diseases especially tumors in abdominal cavity might be the main cause. Partial entercolectomy played an important role in the treatment of this group of subjects.