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肠套叠起病急,发展快,是小儿常见的急腹症之一,好发于2岁以内的儿童,是指一段肠管套入与其相连的肠腔内并造成肠内容物通过障碍。主要临床表现为腹痛、呕吐、进食困难等,腹部可触及类圆形包块,患儿常伴有果酱样便[1-4]。随着超声技术的发展,目前超声已能够获得丰富的影像资料,在高效诊断的同时,也为治疗提供可靠的指导依据。超声引导下水压灌肠复位因其成功率高、并发症少已被大部分临床医生作为治疗肠套叠的首选方法。国内外学者[5-9]研究过套叠部位、大小及套入长度等与水压灌肠复位成功率之间的关系,但因数据量少、资料不完整等原因,结论相对局限。本研究通过回顾性分析进一步明确影响水压灌肠复位成败的危险因素及其预测价值。现作报道。
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2组患儿性别、年龄差异均无统计学意义(P>0.05);复位失败组患儿血便率和发病时间均明显高于复位成功组(P < 0.01)(见表 1)。
分组 n 年龄/月 男 女 血便 发病时间/h 有 无 复位成功组 100 15.7±8.9 71(71.0) 29(29.0) 41(41.0) 59(59.0) 13.4±5.2 复位失败组 26 13.8±4.8 18(69.2) 8(30.8) 20(76.9) 6(23.1) 21.0±9.9 χ2 — 1.47* 0.03 10.67 3.83* P — >0.05 >0.05 < 0.01 < 0.01 *示t值 表 1 2组患儿基本资料的比较[n;百分率(%)]
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2组在有无盆腔积液、肠套叠位置、血流分布、同心圆宽径、同心圆厚径、套鞘厚径、套入长度方面差异均有统计学意义(P < 0.05~P < 0.01),2组在肠系膜淋巴结肿大方面差异无统计学意义(P>0.05)(见表 2)。
分组 n 同心圆宽径/cm 同心圆厚径/cm 套鞘厚径/cm 套入长度/cm 血流分布/级 Ⅰ~Ⅱ Ⅲ~Ⅳ 复位成功组 100 2.7±0.47 2.4±0.27 0.74±0.19 3.9±0.66 23(23.0) 77(77.0) 复位失败组 26 3.5±0.76 2.6±0.43 0.94±0.11 5.3±0.79 18(69.2) 8(30.8) χ2 — 4.57* 2.79* 6.71* 8.96* 20.10 P — < 0.01 < 0.05 < 0.01 < 0.01 < 0.01 分组 n 肠套叠位置 盆腔积液 肠系膜淋巴结肿大 回盲瓣升结肠近端 结肠肝曲或结肠脾曲 回盲瓣小肠近端 有 无 有 无 复位成功组 100 64(64.0) 20(20.0) 16(16.0) 16(16.0) 84(84.0) 53(53.0) 47(47.0) 复位失败组 26 8(30.8) 12(46.2) 6(23.1) 18(69.2) 8(30.8) 14(46.2) 12(53.8) χ2 — 10.14 29.70 0.01 P — < 0.05 < 0.01 >0.05 *示t值 表 2 2组患儿超声表现比较[n;百分率(%)]
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以复位结果为因变量,有统计学意义的因素为自变量,进行二元logistic回归分析,结果显示,同心圆宽径、血便、发病时间及套筒长度均是小儿肠套叠水压灌肠复位结果的独立影响因素(P < 0.01)(见表 3)。
变量 B SE Waldχ2 P OR 95%CI 同心圆宽径 1.45 0.54 7.12 < 0.01 4.25 1.47~12.29 血便 3.02 0.92 10.74 < 0.01 20.54 3.37~125.12 发病时间 0.20 0.06 10.14 < 0.01 1.23 1.08~1.14 套筒长度 0.13 0.04 11.89 < 0.01 1.14 1.06~1.23 表 3 小儿肠套叠水压灌肠复位成功影响因素的logistic回归分析
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同心圆宽径、血便、发病时间、套筒长度联合预测小儿肠套叠水压灌肠复位结果的特异度为89.3%,敏感度为88.8%,AUC为0.933,特异度及敏感度均高于单独预测(P < 0.05)(见表 4)。
指标 AUC P 截取值 特异度/% 敏感度/% 同心圆宽径 0.748 < 0.05 3.35 91.8 57.1 血便 0.794 < 0.05 — 60.2 78.6 发病时间 0.749 < 0.05 19.50 89.8 53.6 套筒长度 0.810 < 0.05 5.15 90.8 64.3 联合预测 0.933 < 0.05 — 89.3 88.8 表 4 不同指标对水压灌肠复位结果的预测价值
小儿肠套叠超声表现与水压灌肠复位成败的相关性
Correlation between the ultrasonographic performance of intussusception and success or failure of hydraulic enema reduction in children
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摘要:
目的探讨影响水压灌肠复位成败的影响因素及其预测价值。 方法回顾性分析小儿肠套叠126例临床资料,按照复位是否成功,分为复位成功组100例和复位失败组26例,比较2组基本资料和超声表现,采用logistic回归分析水压灌肠复位的影响因素,采用ROC曲线分析不同指标对复位成败的预测价值。 结果复位成功组与失败组在有无血便、盆腔积液和肠套叠位置、血流分布、发病时间、同心圆宽径、同心圆厚径、套鞘厚径、套入长度方面差异均有统计学意义(P < 0.05~P < 0.01);logistic回归分析显示,同心圆宽径、血便、发病时间及套筒长度均为水压灌肠复位的独立影响因素(P < 0.01);以上指标联合预测复位成功的特异度为89.3%,敏感度为88.8%,AUC为0.933,特异度及敏感度均高于单独预测(P < 0.05)。 结论超声多指标联合临床资料可对水压灌肠复位结果进行有效预测,有助于减轻患儿痛苦及降低无效治疗风险。 Abstract:ObjectiveTo discuss the factors influencing the success or failure of hydraulic enema reduction and its predictive value. MethodsThe clinical data of 126 children with intussusceptions were retrospectively analyzed.The cases were divided into the success group(100 cases)and failure group(26 cases)according to whether the reduction was successful or not.The basic data and ultrasonic performance between two groups were compared.The logistic regression analysis was used to analyze the influencing factors of the reduction of hydraulic enema, and the ROC curve was used to analyze the predictive value of different indicators for the success or failure of reduction. ResultsThe differences of blood stool, pelvic effusion, intusculation location, blood flow distribution, onset time, concentric circle wide diameter, concentric circle thick diameter, sheath thick diameter and sleeve length were statistically significant(P < 0.05 to P < 0.01).The results of logistic regression analysis showed the width diameter of concentric circles, bloody stool, duration of intussusception and length of intussusception were the independent risk factors of reduction(P < 0.01).The specificity, sensitivity and AUC of combined prediction of the above factors were 89.3%, 88.8% and 0.933, respectively, and the specificity and sensitivity were higher than those of separate prediction(P < 0.05). ConclusionsThe ultrasound finding combined with clinical data can effectively predict the outcome of hydraulic enema reduction, and reduce the pain of children and risk of ineffective treatment. -
Key words:
- intussusception in children /
- ultrasound /
- hydraulic enema reduction
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表 1 2组患儿基本资料的比较[n;百分率(%)]
分组 n 年龄/月 男 女 血便 发病时间/h 有 无 复位成功组 100 15.7±8.9 71(71.0) 29(29.0) 41(41.0) 59(59.0) 13.4±5.2 复位失败组 26 13.8±4.8 18(69.2) 8(30.8) 20(76.9) 6(23.1) 21.0±9.9 χ2 — 1.47* 0.03 10.67 3.83* P — >0.05 >0.05 < 0.01 < 0.01 *示t值 表 2 2组患儿超声表现比较[n;百分率(%)]
分组 n 同心圆宽径/cm 同心圆厚径/cm 套鞘厚径/cm 套入长度/cm 血流分布/级 Ⅰ~Ⅱ Ⅲ~Ⅳ 复位成功组 100 2.7±0.47 2.4±0.27 0.74±0.19 3.9±0.66 23(23.0) 77(77.0) 复位失败组 26 3.5±0.76 2.6±0.43 0.94±0.11 5.3±0.79 18(69.2) 8(30.8) χ2 — 4.57* 2.79* 6.71* 8.96* 20.10 P — < 0.01 < 0.05 < 0.01 < 0.01 < 0.01 分组 n 肠套叠位置 盆腔积液 肠系膜淋巴结肿大 回盲瓣升结肠近端 结肠肝曲或结肠脾曲 回盲瓣小肠近端 有 无 有 无 复位成功组 100 64(64.0) 20(20.0) 16(16.0) 16(16.0) 84(84.0) 53(53.0) 47(47.0) 复位失败组 26 8(30.8) 12(46.2) 6(23.1) 18(69.2) 8(30.8) 14(46.2) 12(53.8) χ2 — 10.14 29.70 0.01 P — < 0.05 < 0.01 >0.05 *示t值 表 3 小儿肠套叠水压灌肠复位成功影响因素的logistic回归分析
变量 B SE Waldχ2 P OR 95%CI 同心圆宽径 1.45 0.54 7.12 < 0.01 4.25 1.47~12.29 血便 3.02 0.92 10.74 < 0.01 20.54 3.37~125.12 发病时间 0.20 0.06 10.14 < 0.01 1.23 1.08~1.14 套筒长度 0.13 0.04 11.89 < 0.01 1.14 1.06~1.23 表 4 不同指标对水压灌肠复位结果的预测价值
指标 AUC P 截取值 特异度/% 敏感度/% 同心圆宽径 0.748 < 0.05 3.35 91.8 57.1 血便 0.794 < 0.05 — 60.2 78.6 发病时间 0.749 < 0.05 19.50 89.8 53.6 套筒长度 0.810 < 0.05 5.15 90.8 64.3 联合预测 0.933 < 0.05 — 89.3 88.8 -
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