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小肠和结肠肠套叠可以是一过性的吗?一项前瞻性研究。

Can intussusceptions of small bowel and colon be transient? A prospective study.

机构信息

Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China.

State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.

出版信息

Eur J Pediatr. 2019 Oct;178(10):1537-1544. doi: 10.1007/s00431-019-03455-z. Epub 2019 Aug 24.

Abstract

We performed a prospective study to explore a diagnosis and treatment protocol of transient intussusception in children (TIC). Totally, 143 children with intussusception who met the inclusion criteria were firstly divided into intussusception involving only the small bowel and intussusception involving the colon group. And in each group, they were further divided into short-segment (≤ 3.0 cm) and long-segment (> 3.0 cm) groups according to the length of intussusception. After a period of conservative treatment, the incidence of TIC, the incidence of surgery, and recurrence were collected and analyzed. Finally, we found that the incidence of TIC in the short-segment group of small bowel intussusception (96.29%) was significantly higher than that in other groups (P ≤ 0.001). Besides, the incidence of surgery and recurrence in this group was relatively low too. Therefore, we summarized the inclusion criteria and treatments to the short-segment group of small bowel intussusception as the suggested protocol to TIC.Conclusion: For cases of small bowel intussusception with no identified pathologic lead point, a short duration of symptoms, a length of ≤ 3.0 cm, a relatively abundant vascular flow signal, and a stable general condition, the spontaneous reduction could be expected and a period of conservative treatment with careful monitoring is recommended. What is Known: • The phenomenon of spontaneous reduction in intussusception (transient intussusception) among pediatric patients has been widely reported. • To distinguish the transient intussusception from the other types is important for the transient ones only need conservative treatment rather than enema reduction or surgery. What is New: • This is the first prospective study to explore a diagnosis and treatment protocol of transient intussusception in children. • Short-segment small bowel intussusceptions have a higher rate (96.29%) to get spontaneous reduction than the other types of intussusception.

摘要

我们进行了一项前瞻性研究,旨在探索儿童暂时性肠套叠(TIC)的诊断和治疗方案。共有 143 名符合纳入标准的肠套叠患儿首先分为仅累及小肠的肠套叠组和累及结肠的肠套叠组。在每组中,根据肠套叠的长度进一步分为短段(≤3.0cm)和长段(>3.0cm)组。经过一段时间的保守治疗,收集并分析 TIC 的发生率、手术率和复发率。最后,我们发现短段小肠肠套叠组 TIC 的发生率(96.29%)明显高于其他组(P≤0.001)。此外,该组的手术率和复发率也相对较低。因此,我们总结了短段小肠肠套叠组的纳入标准和治疗方法,作为 TIC 的建议方案。结论:对于无明确病理原因、症状持续时间短、长度≤3.0cm、相对丰富的血流信号、一般情况稳定的小肠肠套叠患者,可期待自发复位,建议采用保守治疗并密切监测。已知:• 小儿肠套叠(暂时性肠套叠)自发复位的现象已被广泛报道。• 区分暂时性肠套叠和其他类型的肠套叠很重要,因为前者仅需要保守治疗,而不是灌肠复位或手术。新发现:• 这是第一项探索儿童暂时性肠套叠诊断和治疗方案的前瞻性研究。• 短段小肠肠套叠自发复位率(96.29%)高于其他类型的肠套叠。

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