Department of Surgery, Mayo Clinic Rochester, Rochester, MN 55905, USA.
J Gastrointest Surg. 2011 Oct;15(10):1699-705. doi: 10.1007/s11605-011-1609-4. Epub 2011 Jul 6.
Because most adult intussusceptions are reportedly due to malignancy, operative treatment is recommended. With current availability of computed tomography, we questioned the role of mandatory operative exploration for all adult intussusceptions.
This study is a retrospective review of all adults treated from 1983 to 2008 at a large tertiary referral center for intussusception.
One hundred ninety-six patients had intussusception over the 25-year study period. Computed tomography was obtained in 60% of patients. Neoplasms [malignant, (21%); benign, (24%)] were the commonest etiology; 30% cases were idiopathic. One hundred twenty (61%) patients underwent operative treatment for intussusception. Six of the 58 idiopathic or asymptomatic cases were operated on with negative findings in all. Palpable mass (OR 4.56, p < 0.035), obstructive symptoms (OR 9.13, p < 0.001) or obstruction (OR 9.67, p < 0.001), GI bleeding (OR 14.41, p < 0.001), and a lead point on computed tomography (OR 10.08, p < 0.001) were associated with the need for operation.
In the current era of computed tomography, idiopathic or asymptomatic intussusception is being seen more commonly; however, the majority of adult intussusceptions still have pathologic lead points. From our experience, all patients with palpable mass, obstructive symptoms or obstruction, gastrointestinal bleeding, or a lead point on computed tomography should undergo operative exploration.
因为大多数成人肠套叠据报道是由恶性肿瘤引起的，所以建议进行手术治疗。由于目前有计算机断层扫描（CT）可用，我们质疑对所有成人肠套叠都进行强制性手术探查的必要性。
本研究回顾性分析了 1983 年至 2008 年在一家大型三级转诊中心治疗的所有成人肠套叠患者。
在 25 年的研究期间，共有 196 名患者患有肠套叠。60%的患者获得了 CT 检查。肿瘤[恶性（21%），良性（24%）]是最常见的病因；30%的病例为特发性。120（61%）例患者因肠套叠接受了手术治疗。在 58 例特发性或无症状病例中，有 6 例进行了手术，所有病例均未发现阳性结果。可触及肿块（OR 4.56，p<0.035）、梗阻症状（OR 9.13，p<0.001）或梗阻（OR 9.67，p<0.001）、胃肠道出血（OR 14.41，p<0.001）和 CT 上的铅点（OR 10.08，p<0.001）与手术需要相关。
在当前 CT 时代，特发性或无症状性肠套叠更为常见；然而，大多数成人肠套叠仍然存在病理性铅点。根据我们的经验，所有有可触及肿块、梗阻症状或梗阻、胃肠道出血或 CT 上的铅点的患者都应进行手术探查。
