Lee Dong Hyun, Kim Se Jin, Lee Hee Jung, Jang Hyo-Jeong
Department of Pediatrics, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea.
Department of Radiology, Keimyung University School of Medicine, Daegu, Korea.
Pediatr Gastroenterol Hepatol Nutr. 2019 Mar;22(2):142-151. doi: 10.5223/pghn.2019.22.2.142. Epub 2019 Mar 7.
The aim of the study was to identify factors related to the recurrence of intussusception in pediatric patients.
The medical charts of patients diagnosed with intussusception and treated at Dongsan Medical Center, between March 2015 to June 2017, were retrospectively reviewed. Univariate and multivariate analyses were performed.
Among 137 patients, 23 patients (16.8%) had a recurrent intussusception and 8 of these patients (6%) had more than 2 episodes of recurrence. The age at diagnosis was significantly different between the non-recurrence and recurrence group (=0.026), with age >1 year at the time of diagnosis associated with a greater rate of recurrence (=0.002). The time interval from symptom onset to the initial reduction (<48 vs. ≥48 hours) was significantly longer in the recurrence group (=0.034) and patients in the recurrence group had higher levels of C-reactive protein (CRP) (=0.024). Bloody stools and a history of infection were significantly more frequent in the non-recurrence group (=0.001 and <0.001, respectively). On stepwise regression analysis, age >1 year at the time of presentation (odds ratio [OR], 4.79; 95% confidence interval [CI], 1.56-14.06; =0.016) and no history of infection (OR, 0.18; 95% CI, 0.06-0.58; =0.004) were retained as predictors of recurrence.
Patients with intussusception who are older than 1 year at diagnosis, have an elevated CRP level, a delay of ≥48 hours between symptom onset and the initial reduction, an absence of bloody stools, and no history of infection should be closely monitoring for symptoms and signs of a possible recurrence.
本研究旨在确定与小儿肠套叠复发相关的因素。
回顾性分析2015年3月至2017年6月在东三医疗中心诊断并治疗的肠套叠患者的病历。进行单因素和多因素分析。
137例患者中,23例(16.8%)发生复发性肠套叠,其中8例(6%)复发2次以上。非复发组和复发组的诊断年龄有显著差异(P=0.026),诊断时年龄>1岁与较高的复发率相关(P=0.002)。复发组症状出现至首次复位的时间间隔(<48小时与≥48小时)明显更长(P=0.034),且复发组患者的C反应蛋白(CRP)水平更高(P=0.024)。非复发组便血和感染史明显更常见(分别为P=0.001和P<0.001)。逐步回归分析显示,就诊时年龄>1岁(比值比[OR],4.79;95%置信区间[CI],1.56 - 14.06;P=0.016)和无感染史(OR,0.18;95%CI,0.06 - 0.58;P=0.004)是复发的预测因素。
诊断时年龄大于1岁、CRP水平升高、症状出现至首次复位延迟≥48小时、无便血且无感染史的肠套叠患者应密切监测是否有复发的症状和体征。