Yang Gang, Wang Xuejun, Jiang Wenjun, Ma Junmei, Zhao Jinliang, Liu Wenying
Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China.
Pediatr Surg Int. 2013 Dec;29(12):1273-9. doi: 10.1007/s00383-013-3345-1. Epub 2013 Jul 13.
Postoperative intussusception (POI) is an unusual complication in children and infants who underwent various kinds of surgery. The early recognition was difficult for its rarity and atypical presentations. This study evaluates the clinical features of POI through a literature review.
MEDLINE database was searched for relevant articles that reported the children and infants with POI since 1990 in English-language using the key word "postoperative intussusception". All published studies containing clinical data for POI in children and infants were included. Reference lists of retrieved articles were reviewed for additional cases. Detailed data of the included cases were extracted and analyzed.
Twenty-six studies with total 127 cases of POI were included. According to the extracted data, the median age was 19 months with the male-to-female ratio 1.5:1. There were 65 operations (51.2 %) that involved gastrointestinal system, 26 cases (20.5 %) of retroperitoneal tumor resection, 12 operations (9.4 %) involved diaphragm, 8 operations (6.3 %) involved urinary system, 5 cases (3.9 %) of partial pancreatectomy, 11 cases (8.7 %) of non-abdominal operations. 75.5 % presented symptoms in the first 7 days after surgery. The prominent symptom was bilious vomiting or increased nasogastric output (87.1 % of 101 patients), following abdominal distention (74.3 %), abdominal pain (35.6 %). Six cases (5.0 %) of ileocolic POI were reduced successfully by air enema. The small bowel intussusception attributed 85.6 % of POI (95 patients). Laparotomy and manual reduction were performed in 104 cases (86.0 %). Nine patients (7.4 %) underwent intestinal resection and anastomosis.
POI should be suspected in pediatric surgical patients who showed signs of intestinal obstruction in the early postoperative period. Early recognition and prompt management are important.
术后肠套叠（POI）是接受各类手术的儿童和婴儿中一种不常见的并发症。因其罕见性和非典型表现，早期识别较为困难。本研究通过文献综述评估POI的临床特征。
使用关键词“术后肠套叠”在MEDLINE数据库中检索自1990年以来用英文报道儿童和婴儿POI的相关文章。纳入所有包含儿童和婴儿POI临床数据的已发表研究。查阅检索文章的参考文献列表以获取更多病例。提取并分析纳入病例的详细数据。
纳入26项研究，共127例POI病例。根据提取的数据，中位年龄为19个月，男女比例为1.5:1。其中65例手术（51.2%）涉及胃肠道系统，26例（20.5%）为腹膜后肿瘤切除术，12例手术（9.4%）涉及膈肌，8例手术（6.3%）涉及泌尿系统，5例（3.9%）为部分胰腺切除术，11例（8.7%）为非腹部手术。75.5%的病例在术后第1周内出现症状。突出症状为胆汁性呕吐或鼻胃管引流量增加（101例患者中的87.1%），其次是腹胀（74.3%）、腹痛（35.6%）。6例（5.0%）回结肠型POI通过空气灌肠成功复位。小肠套叠占POI的85.6%（95例患者）。104例（86.0%）进行了剖腹手术和手动复位。9例患者（7.4%）接受了肠切除吻合术。
对于术后早期出现肠梗阻迹象的小儿外科患者应怀疑有POI。早期识别和及时处理很重要。
