Zhou Yuxiang,Liu Denghui,Wen Jiabing,et al.Clinical characteristics and risk factors for recurrent intussusception in children: A single-center retrospective study[J].Journal of Clinical Pediatric Surgery,2022,21(07):653-657.[doi:10.3760/cma.j.cn101785-202203068-011]
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
- Title:
- Clinical characteristics and risk factors for recurrent intussusception in children: A single-center retrospective study
- Keywords:
- Intussusception/ET; Intussusception/PP; Intussusception/SU; Recurrence; Enema; Risk Factors; Child; Retrospective Studies
- 摘要:
- 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6 874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 6 874例患儿中，无复发组5 498例，复发组1 376例，总复发率为20.0%（1 376/6 874）。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%，290/1 896），手术率最高（20.7%，394/1 896）；>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。
- Abstract:
- 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.
参考文献/References:
[1] Nguyen TX, Nguyen HS, Ho HT.Treatment outcome of acute intussusception in children under two years of age:a prospective cohort study[J].Cureus, 2020, 12(4):e7729.DOI:10.7759/cureus.7729.
[2] Bodnár D, Kiss áL, Réti G.Modern understanding of intussusception and recent trends in management[J].Orv Hetil, 2020, 161(32):1331-1338.DOI:10.1556/650.2020.31779.
[3] Cho MJ, Nam CW, Choi SH, et al.Management of recurrent ileocolic intussusception[J].J Pediatr Surg, 2020, 55(10):2150-2153.DOI:10.1016/j.jpedsurg.2019.09.039.
[4] Jo S, Lim IS, Chae SA, et al.Characteristics of intussusception among children in Korea:a nationwide epidemiological study[J].BMC Pediatr, 2019, 19(1):211.DOI:10.1186/s12887-019-1592-6.
[5] Simanovsky N, Issachar O, Koplewitz B, et al.Early recurrence of ileocolic intussusception after successful air enema reduction:incidence and predisposing factors[J].Emerg Radiol, 2019, 26(1):1-4.DOI:10.1007/s10140-018-1635-6.
[6] Marsicovetere P, Ivatury SJ, White B, et al.Intestinal intussusception:etiology, diagnosis and treatment[J].Clin Colon Rectal Surg, 2017, 30(1):30-39.DOI:10.1055/s-0036-1593429.
[7] Kelley-Quon LI, Arthur LG, Williams RF, et al.Management of intussusception in children:A systematic review[J].J Pediatr Surg, 2021, 56(3):587-596.DOI:10.1016/j.jpedsurg.2020.09.055.
[8] Tonson la Tour A, Desjardins MP, Gravel J.Evaluation of bedside sonography performed by emergency physicians to detect intussusception in children in the emergency department[J].Acad Emerg Med, 2021, 28(8):866-872.DOI:10.1111/acem.14226.
[9] Plut D, Phillips GS, Johnston PR, et al.Practical imaging strategies for intussusception in children[J].AJR Am J Roentgenol, 2020, 215(6):1449-1463.DOI:10.2214/AJR.19.22445.
[10] Ferrantella A, Quinn K, Parreco J, et al.Incidence of recurrent intussusception in young children:A nationwide readmissions analysis[J].J Pediatr Surg, 2020, 55(6):1023-1025.DOI:10.1016/j.jpedsurg.2020.02.034.
[11] Niramis R, Watanatittan S, Kruatrachue A, et al.Management of recurrent intussusception:nonoperative or operative reduction?[J].J Pediatr Surg, 2010, 45(11):2175-2180.DOI:10.1016/j.jpedsurg.2010.07.029.
[12] Yap Shiyi E, Ganapathy S.Intussusception in children presenting to the emergency department:an asian perspective[J].Pediatr Emerg Care, 2017, 33(6):409-413.DOI:10.1097/PEC.0000000000000548.
[13] 胡章春, 谭亚兰, 郭万亮, 等.儿童继发性肠套叠发病原因及治疗效果的研究[J].临床小儿外科杂志, 2018, 17(3):197-201.DOI:10.3969/j.issn.1671-6353.2018.03.008.Hu ZC, Tan YL, Guo WL, et al.Etiologies and therapies of secondary intussusception in children[J].J Clin Ped Sur, 2018, 17(3):197-201.DOI:10.3969/j.issn.1671-6353.2018.03.008.
[14] Bodnár D, Kiss áL, Réti G.Modern understanding of intussusception and recent trends in management[J].Orv Hetil, 2020, 161(32):1331-1338.DOI:10.1556/650.2020.31779.
[15] Kolar M, Pilkington M, Winthrop A, et al.Diagnosis and treatment of childhood intussusception from 1997 to 2016:A population-based study[J].J Pediatr Surg, 2020, 55(8):1562-1569.DOI:10.1016/j.jpedsurg.2020.01.049.
[16] Hutchason A, Sura A, Vettikattu N, et al.Clinical management and recommendations for children with more than four episodes of recurrent intussusception following successful reduction of each:an institutional review[J].Clin Radiol, 2020, 75(11):864-867.DOI:10.1016/j.crad.2020.08.009.
[17] Thanh Xuan N, Huu Son N, Huu Thien H.Treatment outcome of acute intussusception in children under two years of age:a prospective cohort study[J].Cureus, 2020, 12(4):e7729.DOI:10.7759/cureus.7729.
[18] Talabi AO, Famurewa OC, Bamigbola KT, et al.Sonographic guided hydrostatic saline enema reduction of childhood intussusception:a prospective study[J].BMC Emerg Med, 2018, 18(1):46.DOI:10.1186/s12873-018-0196-z.
[19] Xie X, Wu Y, Wang Q, et al.Risk factors for recurrence of intussusception in pediatric patients:A retrospective study[J].J Pediatr Surg, 2018, 53(11):2307-2311.DOI:10.1016/j.jpedsurg.2018.03.023.
[20] Guo WL, Hu ZC, Tan YL, et al.Risk factors for recurrent intussusception in children:a retrospective cohort study[J].BMJ Open, 2017, 7(11):e018604.DOI:10.1136/bmjopen-2017-018604.
备注/Memo
收稿日期:2022-03-22。
基金项目:国家临床重点专科建设项目-湖南省儿童医院小儿外科（湘卫医发[2022]2号）
通讯作者:刘登辉,Email:liudenghui0505@163.com