Department of Surgery, Queen Sirikit National Institute of Child Health (Children's Hospital), Bangkok 10400, Thailand.
J Pediatr Surg. 2010 Nov;45(11):2175-80. doi: 10.1016/j.jpedsurg.2010.07.029.
The aim of this study was to determine how to manage children with recurrence of intussusception.
Medical records of patients treated for intussusception from 1976 to 2008 at the Queen Sirikit National Institute of Child Health were reviewed. Information on patients who developed recurrent intussusception was extracted to study patterns of recurrent attack and suitable management procedures. The statistical differences were analyzed by the χ² and the Student t test, with a P value < .05 considered significant.
During the study period, 1340 patients were treated for 1448 episodes of intussusceptions, with an average of 40 cases per year. There were 108 episodes of recurrent intussusception in 75 patients (45 males and 30 females). The overall recurrence rate was 8%. Patient age at the first episode ranged from 3 months to 12 years (average, 14.9 months). The time interval before each recurrence ranged from 1 day to 3.2 years (average, 7.8 months). The number of recurrences ranged from 1 to 5 attacks. Recurrent intussusception occurred in 35 (15.8%) of 222 children following successful hydrostatic barium enema (BE) reduction and in 55 (11.4%) of 482 after successful pneumatic or air enema (AE) reduction. There was no statistical difference between the recurrence rates after the 2 nonoperative procedures (P = .08). Recurrent intussusception developed in 14 (3.0%) of 457 patients after operative manual reduction. Recurrence was not observed after intestinal resection for initial irreducible intussusception in 175 patients. The remaining 4 recurrent episodes occurred after spontaneous reduction. Of the 108 episodes of recurrence, BE and AE reductions were successful in 25 (96.2%) of 26 attempts and in 57 (92%) of 62 attempts, respectively. Seven patients had their first episode of intussusception treated surgically. All 7 when they recurred were successfully treated with either BE or AE reduction. Operative intervention was needed in 23 episodes of recurrent intussusception; 18 were reduced manually, and 5 required intestinal resection. Overall, 7 (9.3%) of the 75 recurrences had a pathologic lead point: colonic polyps in 4 cases and Meckel diverticulum in 3 cases. There were no deaths among the 75 patients with recurrent intussusception.
Recurrent intussusception should be initially treated by nonoperative reduction. Laparotomy is needed in cases with failure of BE or AE reduction, in cases with suspicion of a pathologic lead point, and in selected cases with several episodes of recurrence. The treatment of recurrent intussusception, in general, should be similar to that of primary intussusception.
本研究旨在探讨如何处理小儿肠套叠复发。
回顾性分析 1976 年至 2008 年在泰国诗丽吉王后国家儿童医院接受肠套叠治疗的患者的病历资料。提取发生复发性肠套叠患者的信息，研究复发发作的模式和合适的管理程序。采用 χ²和 Student t 检验分析统计学差异，P 值<.05 为差异有统计学意义。
研究期间，1340 例患者共发生 1448 例肠套叠，平均每年 40 例。75 例患者共发生 108 例复发性肠套叠（45 例男性，30 例女性）。总复发率为 8%。首次发作时患者年龄为 3 个月至 12 岁（平均 14.9 个月）。每次复发之间的时间间隔为 1 天至 3.2 年（平均 7.8 个月）。复发次数为 1 至 5 次。222 例成功水压灌肠复位（BE）后复发 35 例（15.8%），482 例成功气灌肠或空气灌肠（AE）复位后复发 55 例（11.4%）。两种非手术治疗后复发率无统计学差异（P=0.08）。14 例（3.0%）在成功手法复位后复发。175 例因初始不可复位性肠套叠而行肠切除术的患者未出现复发。其余 4 例复发发生在自发性复位后。在 108 例复发中，26 次 BE 和 AE 复位成功 25 次（96.2%），62 次复位成功 57 次（92%）。7 例患者的首次肠套叠治疗采用手术。当他们再次出现肠套叠时，均通过 BE 或 AE 复位成功治疗。23 例复发性肠套叠需要手术干预；18 例采用手法复位，5 例需要肠切除术。总体而言，75 例复发性肠套叠中有 7 例（9.3%）存在病理性肠套叠：4 例为结肠息肉，3 例为 Meckel 憩室。75 例复发性肠套叠患者无死亡病例。
复发性肠套叠应首先采用非手术复位治疗。在 BE 或 AE 复位失败、怀疑存在病理性肠套叠、以及反复发作时，需要行剖腹探查术。复发性肠套叠的治疗原则与原发性肠套叠相同。
