小婴儿嵌顿性腹股沟斜疝临床分析及肠坏死高危因素研究

Analysis of clinical characteristics and high-risk factors of intestinal necrosis in infants with incarcerated inguinal hernia

摘要:

目的：探讨小婴儿嵌顿性腹股沟斜疝临床特点及发生肠坏死的高危因素。方法：回顾性研究2013年1月到2017年1月于重庆医科大学附属儿童医院行手术治疗的246例小婴儿嵌顿性腹股沟斜疝的病历资料，分析其临床特点，并依据单因素及多因素logistic回归分析患儿临床资料及实验室检查结果，探究肠坏死发生的高危因素。结果：本组患儿肠坏死发生率为10.2%（25/246），未发生卵巢坏死；多因素logistic回归分析显示，C反应蛋白（C-reactive protein，CRP）异常（OR=26.933, 95%CI=6.396~113.894，P=0.000）为小婴儿嵌顿性腹股沟斜疝肠坏死发生的独立危险因素，ROC曲线分析显示在肠坏死的诊断中，CRP灵敏度和特异度分别为80.0%、93.7%，曲线下面积为0.868（95%CI=0.820~0.908）。结论：小婴儿嵌顿性腹股沟斜疝临床表现不典型，易发生肠坏死；CRP对诊断小婴儿嵌顿性腹股沟斜疝致肠坏死有较好的诊断价值。

Abstract:

Objective：To explore the clinical characteristics and high-risk factors of intestinal necrosis in infants with incarcerated in－guinal hernia. Methods：This retrospective study enrolled 246 infants of incarcerated inguinal hernia at Children’s Hospital of Chongqing Medical University from January 2013 to January 2017. The clinical characteristics were studied and the high-risk factors of intestinal necrosis were identified by univariate analysis and mutivariate logistic regression analysis. Results：The overrall rate of intestinal necrosis was 10.2%（25/246）. Multivariate analysis showed that C-reactive protein（CRP）＞8 mg/L was the independent risk factor of intestinal necrosis in infants with incarcerated inguinal hernia. The ROC analysis showed that in the diagnosis of intestinal necrosis，CRP had a high sensitivity（80.0%） and specificity（93.7%），AUC ROC of 0.868（95%CI=0.820-0.908）. Conclusion：The clinical manifestation of incarcerated inguinal hernia in infants is atypical and incarcerated inguinal hernia in young infants can leads to intestinal necrosis easily. CRP has a good value in diagnosis of intestinal necrosis in infants with incarcerated inguinal hernia.