目的：探讨超声检查评估婴幼儿急性肠套叠是否可行温生理盐水灌肠复位的价值。方法：回顾分析2010年1月—2014年12月间收治的婴幼儿肠套叠病例，患儿分为手术组和温生理盐水复位组。对其一般临床资料、超声资料、治疗及结果进行收集及分析。结果：92例婴幼儿急性肠套叠，其中男50例，女42例，年龄3月~8岁，61例患儿接受温生理盐水灌肠复位治疗，31例经手术治疗。手术组患儿套筒征的长度、靶环征的直径及套叠鞘部的厚度分别为6.48 cm、2.85 cm、0.78 cm，而温生理盐水复位组患儿套筒征的长度、靶环征的直径及套叠鞘部的厚度分别为3.4 cm，1.78 cm和0.36 cm（均P<0.001）。多元回归分析显示套筒征的长度、靶环征的直径及套叠鞘部的厚度是预测温生理盐水灌肠复位是否成功的独立影响因素。ROC曲线分析显示套筒征的长度≥4.5 cm，靶环征的直径≥2.5 cm，鞘部的厚度≥0.5 cm是预测需要手术治疗的最佳界值。结论：超声测量套筒征的长度<4.5 cm，靶环征的直径<2.5 cm，鞘部的厚度<0.5 cm的肠套叠患儿可行温生理盐水灌肠复位治疗。
Abstract
Objective: To investigate the feasibility of ultrasound-guided warm saline enema therapy in infants with acute intussusception. Methods: The clinical data of patients with infant acute intussusception from Jan. 2010 to Dec. 2014 were collected and analyzed retrospectively． Patients were divided into operation and warm saline enema groups． Results: There were 92 cases of infant acute intussusception(50 males and 42 females, age ranging from 3 months to 8 years), 61 patients were cured with warm saline enema and 31 patients underwent surgery. The mean length, diameter and thickness of the intussusception were 3.54 cm, 1.78 cm and 0.36 cm respectively in the warm saline enema group, and 6.48 cm, 2.85 cm and 0.78 cm respectively in the operation group(P<0.001)． Multivariate regression analysis indicated that the “sleeve sign” length, “target ring sign” diameter and “sheath” thickness were independent influencing factors for the success of warm saline enema． ROC curve analysis indicated that the “sleeve sign” length≥4.5 cm, “target ring sign” diameter≥2.5 cm and “sheath” thickness≥0.5 cm of intussusception were optimal cutoff values to predict the need for surgery. Conclusion: The “sleeve sign” length<4.5 cm, “target ring sign” diameter<2.5 cm, and “sheath” thickness<0.5 cm predict the need for warm saline enema in pediatric patients with infant acute intussusception．
关键词
肠套叠 /
灌肠 /
超声检查
Key words
Intussusception /
Enema /
Ultrasonography
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