成人肠套叠的临床分析  

Clinical analysis of adult intussusception

作　　者：李亮 刘颖涵 王广智[1] LI Liang;LIU Ying-han;WANG Guang-zhi(Department of General Surgery,Second Affiliated Hospital of Dalian Medical University,Dalian 116021,China)

机构地区：[1]大连医科大学附属第二医院,116021

出　　处：《中国实用医药》2021年第31期44-46,共3页China Practical Medicine

基　　金：大连市高层次人才创新、科技人才创业和重点领域创新团队支持计划(项目编号:2019RQ041)。

摘　　要：目的 探讨成人肠套叠的病因、临床特点、诊断及治疗方法。方法 回顾性分析46例成人肠套叠的临床资料。结果 成人肠套叠的主要临床表现为:腹痛(43例、93.5%),其他表现包括恶心呕吐(25例、54.3%)、肛门停止排气排便(13例、28.3%)、便血(12例、26.1%)、腹部包块(6例、13.0%)、腹泻(5例、10.9%)等。腹部CT是成人肠套叠最主要的检查方法,其他检查包括腹部超声、结肠镜检查。37例患者行手术治疗,35例患者治愈出院,2例术后死亡;6例患者接受保守治疗;3例拒绝治疗,签字离院。37例手术患者的主要病因为:恶性肿瘤16例(43.2%)(腺癌9例、胃肠间质瘤1例、炎性肌纤维母细胞瘤2例、非霍奇金淋巴瘤1例、宫颈癌小肠转移1例、黑色素瘤转移1例、小肠恶性周围神经鞘膜瘤1例),良性肿瘤和息肉7例(18.9%)(脂肪瘤3例、炎性纤维性息肉3例、绒毛状管状腺瘤1例),其他病变8例(21.6%)(术后粘连4例、梅克尔憩室2例、P-J综合征2例),特发性肠套叠6例(16.2%)。结论 成人肠套叠临床少见,多由器质性病变引起,主要为肠道良恶性肿瘤。成人肠套叠最主要的临床表现是腹痛,检查主要依靠腹部CT,治疗则以手术为主。Objective To discuss the etiology,clinical features,diagnosis and treatment of adult intussusception.Methods The clinical data of 46 cases of adult intussusception were retrospectively analyzed.Results The main clinical manifestations of intussusception in adults were abdominal pain(43 cases,93.5%),and other manifestations included nausea and vomiting(25 cases,54.3%),anal cessation of anal exhaust and defecation(13 cases,28.3%),blood in the stool(12 cases,26.1%),abdominal mass(6 cases,13.0%),and diarrhea(5 cases,10.9%).Abdominal CT was the most important examination method for adult intussusception,and other examinations included abdominal ultrasound and colonoscopy.37 patients were treated surgically,35 patients were cured and discharged,2 patients died after surgery;6 patients received conservative treatment;3 patients refused treatment and signed out of the hospital.The main etiologies of the 37 surgical patients were malignant tumors in 16 cases(43.2%)(adenocarcinoma in 9 cases,gastrointestinal stromal tumor in 1 case,inflammatory myofibroblastoma in 2 cases,non-Hodgkin’s lymphoma in 1 case,small bowel metastasis from cervical cancer in 1 case,melanoma metastasis in 1 case,malignant peripheral nerve sheath tumor of the small intestine in 1 case),benign tumors and polyps in 7 cases(18.9%)(lipoma in 3 cases,inflammatory fibrous polyp in 3 cases,villous tubular adenoma in 1 case),other lesions 8 cases(21.6%)(postoperative adhesions in 4 cases,Meckel’s diverticulum in 2 cases,P-J syndrome in 2 cases),and idiopathic intussusception in 6 cases(16.2%).Conclusion Adult intussusception is rare in clinical practice.It is mostly caused by organic diseases,mainly benign and malignant tumors of the intestine.The main clinical manifestation of adult intussusception is abdominal pain.The examination mainly relies on abdominal CT,and the common treatment is surgery.

关 键 词：肠套叠 成人 诊断 治疗 

分 类 号：R574.3[医药卫生—消化系统]