小儿幽门管溃疡36例  

Pyloric Canal Ulcer in 36 Children

作　　者：陈昌斌[1] 游洁玉[1] 陈志勇[1] 欧阳文献[1] 罗艳红[1] 赵红梅[1] 段柏萍[1] 

机构地区：[1]湖南省儿童医院消化内科,长沙410007

出　　处：《实用儿科临床杂志》2011年第7期515-517,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨小儿幽门管溃疡的临床特点、诊断及治疗方法。方法回顾性分析36例（男22例,女14例;年龄6个月-12岁）幽门管溃疡的的临床表现、胃镜和钡餐检查特点及其治疗和预后。结果以呕吐为首发表现的患儿33例（占91.7%）,伴食欲减退30例,腹痛20例,黑便、消瘦各12例,面色苍黄、腹上区包块各10例;合并不同程度贫血29例,代谢性碱中毒27例,低钠、低钾、低氯血症各18例。胃镜首次检查能通过幽门并发现幽门管溃疡9例,并幽门梗阻且胃镜前端不能通过者27例;对胃镜不能通过者行稀钡餐检查,结果显示幽门管溃疡6例,幽门不完全性梗阻21例。23例（63.9%）经内科保守治疗治愈,13例（36.1%）经手术治疗治愈。结论小儿幽门管溃疡的首发表现为呕吐,胃镜和钡餐检查是确诊幽门管溃疡的主要手段。治疗方面以内科保守治疗为主,幽门管溃疡由于其解剖位置特异,其抑酸治疗的疗程适当延长,主张以4-6周为1个疗程抑酸治疗,患儿不易复发;对少数难以控制的大出血者、幽门完全性梗阻经保守治疗72 h无效者及易复发的多发性幽门管溃疡者应选择手术治疗。Objective To explore the clinical features,diagnosis and treatment of children with pyloric canal ulcer.Methods Medical records of the clinical performance,the characteristics of electronic endoscopy and barium meal examination of 36 hospitalized cases（with the pyloric canal ulcer） including 22 male and 14 female,aged 6 months to 12 years old and its treatment and prognosis were analyzed retrospectively.Results Vomiting was the first symptom in 33 cases of the 36 children（91.7%）,30 cases with loss of appetite,abdominal pain in 20 cases,melena in 12 cases,weight loss in 12 cases looking greenish yellow on the face in 10 cases;upper abdominal mass in 10 cases;different degrees of anemia in 29 cases,metabolic alkalosis in 27 cases,low sodium and low potassium and low chloride hyperlipidemia in 18 cases.The initial gastroscopy could get through the pylorus and pyloric canal ulcer was found in 9 cases,complicated by pyloric obstruction but the fro-nt-part of gastroscope could not get through the pylorus in 27 cases for which dilute barium meal examination showed pyloric canal ulcer in 6 cases and pyloric obstruction was not complete in 21 cases.Twenty-three cases（63.9%）were cured by conservative medical treatment and 13 cases（36.1%）were cured by surgical treatment.Conclusions Vomiting is the first manifestation in children with pyloric canal ulcer,and gastroscopy and barium meal examination are the primary means to diagnose pyloric canal ulcer.Conservative medical treatment is the main treatment and acid suppression treatment should be appropriately extended in order to reduce recurrence because of specific anatomical location of pyloric canal ulcer,and a course of acid suppression therapy for 4-6 weeks in children is necessary.Surgical treatment should be used in a small number of patients whose bleeding is difficult to be controled or whose multiple pyloric canal ulcer and pyloric obstruction can not be removed and completely by conservative treatment for 72 hours.Using balloon dilation or pneumatic

关 键 词：幽门管溃疡 幽门梗阻 儿童 

分 类 号：R725.7[医药卫生—儿科]