CAJ | 학술논문

目的探讨不同年龄肠套叠患儿的临床表现和诊断治疗特点。方法采用回顾性分析方法分析四川省人民医院儿童医学中心2011年1月至2013年7月收治的76例14岁以下肠套叠患儿的临床病历资料。将其按照患儿年龄分别纳入0~2岁组(n=58)和≥2岁组(n=18)。肠套叠患儿均通过腹部超声检查、空气灌肠或剖腹探查术确诊。采用统计学方法分析两组患儿的临床症状、体格及辅助检查结果、空气灌肠复位、手术治疗、复发情况及病理性起始点有无等(本研究遵循的程序符合四川省人民医院人体试验委员会制定的伦理学标准，得到该委员会批准，分组征得受试对象监护人的知情同意，并与其签署临床研究知情同意书)。结果两组患儿性别、发病至就诊时间比较，差异无统计学意义(P>0.05)。两组患儿的超声检查阳性率、空气灌肠复位成功率、手术治疗率、肠坏死率及复发率比较，差异无统计学意义(P>0.05)。0~2岁组患儿临床表现有典型肠套叠症状者(同时具有阵发性腹痛、呕吐和果酱样大便)占62.1%(36/58)，≥2岁组则为5.6%(1/18)，两组比较，差异有统计学意义(P<0.05)。0~2岁组患儿合并呕吐、血便发生率分别为75.9%(44/58)和0(0/58)，≥2岁组则分别为22.2%(4/18)和5.6%(1/18)，差异均有统计学意义(P<0.05)。本组仅一例6岁患儿证实为回肠幼年性息肉导致的继发性肠套叠(存在 PLP)。结论本组临床病历资料显示，虽然多数急性原发性肠套叠患儿的发病年龄<2岁，但≥2岁患儿仍然存在该病可能，而且≥2岁患儿的肠套叠多数仍为原发性肠套叠，主要临床表现为腹痛，症状典型者罕见，空气灌肠复位对其仍安全有效。
목적탐토불동년령장투첩환인적림상표현화진단치료특점。방법채용회고성분석방법분석사천성인민의원인동의학중심2011년1월지2013년7월수치적76례14세이하장투첩환인적림상병력자료。장기안조환인년령분별납입0~2세조(n=58)화≥2세조(n=18)。장투첩환인균통과복부초성검사、공기관장혹부복탐사술학진。채용통계학방법분석량조환인적림상증상、체격급보조검사결과、공기관장복위、수술치료、복발정황급병이성기시점유무등(본연구준순적정서부합사천성인민의원인체시험위원회제정적윤리학표준，득도해위원회비준，분조정득수시대상감호인적지정동의，병여기첨서림상연구지정동의서)。결과량조환인성별、발병지취진시간비교，차이무통계학의의(P>0.05)。량조환인적초성검사양성솔、공기관장복위성공솔、수술치료솔、장배사솔급복발솔비교，차이무통계학의의(P>0.05)。0~2세조환인림상표현유전형장투첩증상자(동시구유진발성복통、구토화과장양대편)점62.1%(36/58)，≥2세조칙위5.6%(1/18)，량조비교，차이유통계학의의(P<0.05)。0~2세조환인합병구토、혈편발생솔분별위75.9%(44/58)화0(0/58)，≥2세조칙분별위22.2%(4/18)화5.6%(1/18)，차이균유통계학의의(P<0.05)。본조부일례6세환인증실위회장유년성식육도치적계발성장투첩(존재 PLP)。결론본조림상병력자료현시，수연다수급성원발성장투첩환인적발병년령<2세，단≥2세환인잉연존재해병가능，이차≥2세환인적장투첩다수잉위원발성장투첩，주요림상표현위복통，증상전형자한견，공기관장복위대기잉안전유효。
Objective To explore the clinical characteristics and management of intussusception in children of different age groups.Methods Retrospective analysis of the clinical information of 76 patients with intussusception who were younger than 14 years old were recruited.They treated in Sichuan Academy of Medical Sciences and Sichuan Provincial People′s Hospital from January 2011 to July 2013.According to different ages,they were divided into:0-2 years group and ≥ 2 years old group.Their diagnoses results were confirmed by abdominal ultrasonography,pneumatic reduction or laparotomy.Clinical presentations, physical examinations,auxiliary examinations,pneumatic reduction,operations,existing of recurrences and pathological lead point(PLP)were analyzed by statistic methods.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Sichuan Academy of Medical Sciences and Sichuan Provincial People′s Hospital.Informed consent was obtained from the parents of each participating child. Results The sex and duration of manifestation were comparable in both groups, and there had no significant difference (P>0.05 ).There were no significant difference in positive results of ultrasound, success rate of pneumatic reduction,operations,intestinal gangrene and recurrence between two groups (P>0.05).There were significant difference in classic symptoms,such as red currant jelly stool,vomiting between 0-2 years group(62.1%,36/58)and ≥2 years old group(5.6%,1/18)(P<0.05).In 0-2 years group,incidence rates of vomiting and bloody stools were reported in 75.9%(44/58)and 0(0/58),and corresponding frequency in ≥2 years old group were 22.2%(4/18)and 5.6%(1/18),respectively,and had significant difference between this two groups (P<0.05).Only one case of a PLP (ileal juvenile polyp) was found in a 6 years old girl. Conclusions Abdominal pain is the predominant presentation of intussusception in children older than 2 years old.Classic symptoms and intussusception gangrene rarely exist in this group.Pneumatic reduction is safe and effective in both groups.Though the recurrence rate may be higher than in infants,most of the patients older than 2 years were idiopathic.