无痛型肠套叠并发肠坏死5例临床特征分析  

Painless intussusception complicated with intestinal necrosis:a clinical analysis of 5 cases

作　　者：郭玮[1] 李清峰 蒋丽军 GUO Wei;LI Qing-feng;JIANG Li-jun(Department of Pediatrics,Afiliated Hospital of Yangzhou Unitersity,Yangzhou,Jiangsu 225001,China)

机构地区：[1]扬州大学附属医院儿科,江苏扬州225001

出　　处：《中国临床研究》2021年第4期509-512,共4页Chinese Journal of Clinical Research

基　　金：江苏省妇幼健康科研项目(F201858)。

摘　　要：目的探讨无痛型肠套叠临床特点,以早期识别无痛型肠套叠,避免延误诊治。方法回顾性分析2013年6月至2019年12月诊治的5例无痛型肠套叠临床症状、体征、腹部彩超、腹部CT、术中探查结果、病理检查等临床资料。结果 5例患儿中男3例,女2例,年龄为4个月~4岁1个月,其初始临床表现不典型,均未能在初期确诊。具体的临床表现:5例患儿均无哭闹;5例表现精神差、面色苍白、血便;4例出现呕吐、发热;3例脱水、发现腹部包块、直肠指检触及包块;2例有腹胀。5例患儿分别于病程的第2(1例)、3(3例)、4(1例)天行剖腹探查,并通过病理证实为肠套叠伴肠坏死。术后均予禁食、抗感染、静脉营养等对症支持治疗,5例患儿均预后良好,顺利出院。结论婴儿无痛型肠套叠临床表现不典型,容易并发肠坏死,当有便血、不明原因呕吐,继而出现精神萎靡时,应注重腹部包块、直肠指检查体,适时反复查腹部彩超,必要时进行剖腹探查。避免延误最佳的治疗时机而导致肠坏死、肠穿孔、休克等严重并发症。Objective To investigate the clinical features of painless intussusception in order to identify it early and avoid delay in diagnosis and treatment.Methods A retrospective analysis was performed on the clinical data of 5 patients with painless intussusception treated from June 2013 to December 2019,including clinical symptoms, signs, abdominal color Doppler ultrasound and abdominal CT findings, intraoperative confirmation and pathological examination.Results There were 3 males and 2 females, aged from 4 months to 4 years and 1 month old.The diagnosis could not be confirmed at the initial stage becaused of atypical clinical manifestations.The specific clinical manifestations were no-crying in 5 cases, mental fatigue, pale complexion and bloody stool in 5 cases, vomiting and fever in 4 cases, dehydration, abdominal mass and rectal mass revealed by digital rectal examination in 3 cases and abdominal distension in 2 cases.Exploratory laparotomies were respectively performed on 1 patient on the 2 nd day of disease, 3 patients on the 3 rd day of disease and 1 patient on the 4 th day of disease, and the intussusception with intestinal necrosis was confirmed by pathology.After operation, all patients were treated with symptomatic and supportive treatment such as fasting, anti-infection, intravenous nutrition.All patients were discharged from hospital with good prognosis.Conclusions The clinical manifestation of infant painless intussusception is atypical and easy to be complicated with intestinal necrosis.When the patient presented with hematochezia, vomiting and mental fatigue, the more attention should be paied in abdominal mass, which can be revealed by digital rectal examination and repeatedly abdominal color Doppler ultrasound.Exploratory laparotomy is performed if necessary in order to avoid leading to intestinal necrosis, intestinal perforation, shock and other serious complications.

关 键 词：无痛型肠套叠 肠坏死 腹部包块 直肠指检 腹部超声波 

分 类 号：R726.5[医药卫生—儿科]