儿童过敏性紫癜合并肠套叠临床诊治分析
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摘要
目的通过分析过敏性紫癜合并肠套叠患儿的诊治情况,了解该病的临床表现,选择合适治疗方式。方法收集该院2006年1月至2016年12月收治的45例过敏性紫癜合并肠套叠患儿,对其一般资料、临床表现、影像学检查、治疗情况等进行分析。结果 45例患儿中,男30例,女15例,皮肤紫癜45例(100.0%)、腹痛45例(100.0%)、呕吐40例(88.9%)、血便26例(57.8%)、发热13例(28.9%)、腹部包块11例(24.4%)。35例患儿皮肤紫癜先出现,2例患儿皮肤紫癜和腹部症状同时出现,8例患儿腹部症状先出现。所有患儿彩色多普勒超声检查均提示"同心圆"及"假肾征"。6例患儿直接行手术治疗,39例先行空气灌肠后再行手术治疗,其中16例成功(41.0%),23例失败(59.0%)。10例患儿术中行肠切除术,套入距离为(29±15)cm;19例患儿术中行手法复位,套入距离为(13±6)cm,二者比较,差异有统计学意义(P<0.01)。结论过敏性紫癜常见临床表现有皮肤紫癜、腹痛、呕吐、血便、发热、腹部包块等,过敏性紫癜合并肠套叠空气灌肠治疗成功率较低,手术患儿肠切除率较高。
Objective Through the analysis of intussusception diagnosis and treatment of children with allergic purpura merger case,to understand the clinical manifestations of the disease,and choose appropriate treatment. Methods A total of 45 cases children with allergic purpura combining intussusception were collected from the hospital from January 2006 to December 2016. The general information,clinical manifestations,imaging examination and treatment were analyzed. Results A total of 45 cases included 30 male children,15 female children. Among the 45 cases,skin purpura 45 cases(100.0%),abdominal pain 45 cases(100.0%),vomiting 40 cases(88.9%),bloody stools 26 cases(57.8%),fever 13 cases(28.9%),abdominal mass 11 cases(24.4%). 35 cases appeared skin purpura firstly,2 cases appeared skin purpura and abdominal symptoms at thesame time,8 cases of children with abdominal symptoms came firstly. 6 cases children underwent surgical treatment directly,39 cases firstly received air enema,only 16 cases(41.0%)succeeded,23 cases(59.0%)failed and underwent surgical treatment.10 cases received bowel resection,the average distance was(29±15)cm,and 19 cases received manual reduction,the average distance was(13±6)cm,the difference of distance was statistically significant(P<0.01). Conclusion Common clinical manifestations of allergic purpura are skin purpura,abdominal pain,vomiting,blood,fever,abdominal mass and so on. The success rate of the patients with allergic purpura combining intussusception is lower,and the rate of enterotomy is higher.
Objective Through the analysis of intussusception diagnosis and treatment of children with allergic purpura merger case,to understand the clinical manifestations of the disease,and choose appropriate treatment. Methods A total of 45 cases children with allergic purpura combining intussusception were collected from the hospital from January 2006 to December 2016. The general information,clinical manifestations,imaging examination and treatment were analyzed. Results A total of 45 cases included 30 male children,15 female children. Among the 45 cases,skin purpura 45 cases(100.0%),abdominal pain 45 cases(100.0%),vomiting 40 cases(88.9%),bloody stools 26 cases(57.8%),fever 13 cases(28.9%),abdominal mass 11 cases(24.4%). 35 cases appeared skin purpura firstly,2 cases appeared skin purpura and abdominal symptoms at thesame time,8 cases of children with abdominal symptoms came firstly. 6 cases children underwent surgical treatment directly,39 cases firstly received air enema,only 16 cases(41.0%)succeeded,23 cases(59.0%)failed and underwent surgical treatment.10 cases received bowel resection,the average distance was(29±15)cm,and 19 cases received manual reduction,the average distance was(13±6)cm,the difference of distance was statistically significant(P<0.01). Conclusion Common clinical manifestations of allergic purpura are skin purpura,abdominal pain,vomiting,blood,fever,abdominal mass and so on. The success rate of the patients with allergic purpura combining intussusception is lower,and the rate of enterotomy is higher.
引文
[1]CHEN O,ZHU XB,REN P,et al.Henoch Schonlein Purpura in children:clinical analysis of 120 cases[J].Afr Health Sci,2013,13(1):94-99.
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[8]武静,朱向明,张震.腹部超声联合浅表超声对小儿肠套叠的诊断分析[J].皖南医学院学报,2017,36(6):595-597.
[9]LIOUBASHEVSKY N,HILLER N,ROZOVSKY K,et al.Ileocolic ver-sus small-bowel intussusception in children:can US enable reliable dif-ferentiation?[J].Radiology,2013,269(1):266-271.
[10]KIM SH,JUNG SM,LEE JI.Risk factors for surgical procedure on ileo-colic intussusception in children[J].J Korean Assoc Pediatr Surg,2016,22:10-13.
[11]MENON P,SINGH S,AHUJA N,et al.Gastrointestinal manifestationsof Henoch-Schoenlein purpura[J].Dig Dis Sci,2013,58(1):42-45.
[12]贾江坤,申权,余淼,等.儿童腹型过敏性紫癜伴严重肠套叠诊疗分析[J].临床急诊杂志,2016,17(4):320-321.
[13]BOWKER B,RASCATI S.Intussusception[J].JAAPA,2018,31(1):48-49.
[14]VO A,LEVIN TL,TARAGIN B,et al.Management of Intussusceptionin the Pediatric Emergency Department:Risk Factors for Recurrence[J].Pediatr Emerg Care,2017-12-11[2017-11-10].https://www.ncbi.nlm.nih.gov/pubmed/?term=Vo+A%2C+Levin+TL%2C+Taragin+B%2C+Khine+H.+Management+of+Intussusception+in+the+Pediatric+Emer-gency+Department%3A+Risk+Factors+for+Recurrence%5BJ%5D.
[15]PATEL RV,SHETH J,KUMAR H,et al.Laparoscopic reduction ofileoileal intussusception in Henoch-Schonlein purpura[J].BMJ CaseRep,2013,2013.
[16]BURJONRAPPA SC.Laparoscopic reduction of intussusception:anevolving therapeutic option[J].JSLS,2007,11(2):235-237.
[17]ZMORA O,SHIN CE.Multiple surgical interventions due to recurrentintussusception in a patient with henoch-sch?nlein purpura:a case re-port[J].Eur J Pediatr Surg,2008,18(5):340-341.
[18]李斌德,颜禄斌,沈阳,等.过敏性紫癜腹部外科并发症诊治分析[J].中华小儿外科杂志,2014,34(4):310-311.
[2]HE X,YU C,ZHAO P,et al.The genetics of Henoch-Sch?nlein pur-pura:a systematic review and meta-analysis[J].Rheumatol Int,2013,33(6):1387-1395.
[3]BROWN PJ,HAUGHT JM,ENGLISH JC 3rd.Periumbilical purpuraprior to gastrointestinal involvement in Henoch-Sch?nlein purpura[J].Am J Clin Dermatol,2009,10(2):127-130.
[4]JASI?M,SUBAT-DEZULOVI?M,NIKOLI?H,et al.Henoch-Sch?nleinpurpura complicated by appendicitis,intussusception and ureteritis[J].Coll Antropol,2011,35(1):197-201.
[5]柳龚堡,董岿然,沈淳,等.重症腹型紫癜合并外科并发症的治疗[J].中华小儿外科杂志,2012,33(12):905-908.
[6]ACAR B,ARIKAN FI,ALIOGLU B,et al.Successful treatment of gas-trointestinal involvement in Henoch-Sch?nlein purpura with plasma-pheresis[J].Pediatr Nephrol,2008,23(11):2103.
[7]KIM KY.Henoch-Sch?nlein purpura presenting as intussusception[J].Korean J Gastroenterol,2017,69(6):372-376.
[8]武静,朱向明,张震.腹部超声联合浅表超声对小儿肠套叠的诊断分析[J].皖南医学院学报,2017,36(6):595-597.
[9]LIOUBASHEVSKY N,HILLER N,ROZOVSKY K,et al.Ileocolic ver-sus small-bowel intussusception in children:can US enable reliable dif-ferentiation?[J].Radiology,2013,269(1):266-271.
[10]KIM SH,JUNG SM,LEE JI.Risk factors for surgical procedure on ileo-colic intussusception in children[J].J Korean Assoc Pediatr Surg,2016,22:10-13.
[11]MENON P,SINGH S,AHUJA N,et al.Gastrointestinal manifestationsof Henoch-Schoenlein purpura[J].Dig Dis Sci,2013,58(1):42-45.
[12]贾江坤,申权,余淼,等.儿童腹型过敏性紫癜伴严重肠套叠诊疗分析[J].临床急诊杂志,2016,17(4):320-321.
[13]BOWKER B,RASCATI S.Intussusception[J].JAAPA,2018,31(1):48-49.
[14]VO A,LEVIN TL,TARAGIN B,et al.Management of Intussusceptionin the Pediatric Emergency Department:Risk Factors for Recurrence[J].Pediatr Emerg Care,2017-12-11[2017-11-10].https://www.ncbi.nlm.nih.gov/pubmed/?term=Vo+A%2C+Levin+TL%2C+Taragin+B%2C+Khine+H.+Management+of+Intussusception+in+the+Pediatric+Emer-gency+Department%3A+Risk+Factors+for+Recurrence%5BJ%5D.
[15]PATEL RV,SHETH J,KUMAR H,et al.Laparoscopic reduction ofileoileal intussusception in Henoch-Schonlein purpura[J].BMJ CaseRep,2013,2013.
[16]BURJONRAPPA SC.Laparoscopic reduction of intussusception:anevolving therapeutic option[J].JSLS,2007,11(2):235-237.
[17]ZMORA O,SHIN CE.Multiple surgical interventions due to recurrentintussusception in a patient with henoch-sch?nlein purpura:a case re-port[J].Eur J Pediatr Surg,2008,18(5):340-341.
[18]李斌德,颜禄斌,沈阳,等.过敏性紫癜腹部外科并发症诊治分析[J].中华小儿外科杂志,2014,34(4):310-311.