探讨超声诊断是否有病理诱发点(PLP)继发性肠套叠患儿的诊断效能。

选择2019年9月1日至2024年8月31日于西安交通大学附属儿童医院外科及消化内科进行肠套叠手术或内镜复位的187例肠套叠患儿为研究对象。根据手术或病理学检查结果证实是否有PLP，将其分为原发性肠套叠组(无PLP组，n＝110)和继发性肠套叠组(PLP组，n＝77)。PLP组中，肠道息肉患儿为29例(黑斑息肉综合征为20例、幼年性息肉为9例)，梅克尔憩室患儿为20例，肠重复畸形患儿为18例，淋巴瘤患儿为6例，变态反应性紫癜、胃间质瘤、脂肪母细胞瘤及海绵状血管瘤各为1例。采用回顾性分析法比较2组患儿性别、发病年龄、肠套叠复发率、肠套叠长径及横径。以手术或病理学检查结果为继发性肠套叠诊断的"金标准"，计算超声诊断继发性肠套叠的敏感度、特异度、准确率、阳性预测值、阴性预测值及约登指数。本研究遵循的程序经西安交通大学附属儿童医院医学伦理委员会审核批准(审批文号：20240823-05)。

①PLP组患儿的发病年龄及复位后肠套叠复发率，均显著高于无PLP组，并且差异有统计学意义(P<0.05)。②PLP组继发性肠套叠患儿中，PLP类型为肠道息肉、梅克尔憩室、肠重复畸形及淋巴瘤者的发病年龄、复发率和肠套叠长径总体比较，差异均有统计学意义(P<0.05)。肠重复畸形继发肠套叠患儿发病年龄，显著低于肠道息肉、梅克尔憩室及淋巴瘤者，并且差异均有统计学意义(P<0.05)；淋巴瘤继发肠套叠患儿发病年龄，显著高于肠道息肉、肠重复畸形者，并且差异均有统计学意义(P<0.05)；肠重复畸形继发肠套叠患儿复位后复发率，显著低于肠道息肉、梅克尔憩室及淋巴瘤者，并且差异均有统计学意义(P<0.05)，淋巴瘤继发肠套叠患儿的肠套叠横径，显著大于肠道息肉者，差异有统计学意义(P<0.05)；梅克尔憩室继发肠套叠的肠套叠长径，显著长于肠道息肉及淋巴瘤者，差异均有统计学意义(P<0.05)。③PLP组超声检查漏诊继发性肠套叠者为5例，无PLP组超声检查误诊为继发性肠套叠者为15例，超声诊断继发性肠套叠的敏感度为93.5%(72/77)，特异度为86.4%(95/110)，准确率为89.3%(167/187)，阳性预测值为82.8%(72/87)，阴性预测值为95.0%(95/100)，约登指数为0.79。④4种主要类型PLP继发性肠套叠患儿中，肠道息肉、梅克尔憩室、肠重复畸形、淋巴瘤者的超声诊断约登指数分别为0.93、0.58、0.92、0.82。

超声诊断继发性肠套叠患儿的总体敏感度较高，其中对肠道息肉、肠重复畸形及淋巴瘤者具有较高的诊断效能，但是对于梅克尔憩室者诊断效能相对较低。

To evaluate the diagnostic value of ultrasonography in identifying secondary intussusception induced by different pathological lead points (PLP).

A total of 187 pediatric patients with intussusception who underwent surgical or endoscopic reduction in the Department of Surgery or Department of Gastroenterology at the Children′s Hospital of Xi′an Jiaotong University between September 1, 2019 and August 31, 2024, were retrospectively enrolled in this study. According to surgical and/or pathological findings confirming the presence or absence of a PLP, the patients were divided into two groups: PLP group (n=77) and non-PLP group (n=110). In PLP group, the etiologies included intestinal polyp (n=29), Meckel′s diverticulum (n=20), intestinal duplication (n=18), and lymphoma (n=6); Henoch-Schönlein purpura, gastrointestinal stromal tumor, lipoblastoma, and cavernous hemangioma were each observed in one case. Demographic and clinical characteristics, including gender, age, recurrence rate of intussusception, and the longitudinal and transverse diameters of the intussusception, were retrospectively analyzed and compared between two groups. Using surgical or pathological findings as the gold standard, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden index of ultrasonography in diagnosing secondary intussusception were calculated. This study was reviewed and approved by the Ethics Committee of the Children′s Hospital of Xi′an Jiaotong University (Approval No. 20240823-05).

① The age and recurrence rate of patients in PLP group were significantly higher than those in non-PLP group (P<0.05). ② Among patients in PLP group, there were significant overall differences in age, recurrence rate, and length of intussusception among those with intestinal polyp, Meckel′s diverticulum, intestinal duplication, and lymphoma (P< 0.05). Further pairwise comparisons showed that the age of patients with secondary intussusception caused by intestinal duplication was significantly lower than that of patients with intestinal polyp, Meckel′s diverticulum, or lymphoma (P<0.05). Patients with secondary intussusception due to lymphoma were significantly older than those with intestinal polyp or intestinal duplication (P<0.05). The recurrence rate of intussusception in patients with intestinal duplication was significantly lower than that in those with intestinal polyp, Meckel′s diverticulum, or lymphoma (P<0.05). The transverse diameter of intussusception in patients with lymphoma was significantly larger than that in patients with intestinal polyp (P<0.05). The length of intussusception in patients with Meckel′s diverticulum was significantly greater than that in patients with intestinal polyp or lymphoma (P<0.05). ③ In PLP group, five cases of secondary intussusception were missed on ultrasonography, whereas in non-PLP group, 15 cases were misdiagnosed as secondary intussusception. The diagnostic performance of ultrasonography for secondary intussusception was as follows: sensitivity, 93.5% (72/77); specificity, 86.4% (95/110); accuracy, 89.3% (167/187); positive predictive value, 82.8% (72/87); negative predictive value, 95.0% (95/100); and Youden index, 0.79. ④Among the four types of PLP, intestinal polyp, Meckel′s diverticulum, intestinal duplication, and lymphoma, the Youden indices of ultrasonographic diagnosis were 0.93, 0.58, 0.92, and 0.82, respectively.

The overall sensitivity of ultrasonography for diagnosing secondary intussusception was high. It demonstrated good diagnostic performance in cases caused by intestinal polyps, intestinal duplication, and lymphoma, whereas the diagnostic efficacy for secondary intussusception resulting from Meckel′s diverticulum was relatively low.