婴幼儿十二指肠穿孔的临床诊治分析  

Clinical diagnosis and treatment of duodenal perforation in infants

作　　者：侯广军 张飞[1] 张现伟 耿宪杰 张春霞[1] 周良 郜向阳[1] 冯欣[1] 侯栋亮 周崇臣 Hou Guangjun;Zhang Fei;Zhang Xianwei;Geng Xianjie;Zhang Chunxia;Zhou Liang;Gao Xiangyang;Feng Xin;Hou Dongliang;Zhou Chongchen(Department of General Surgery, Affiliated Children's Hospital, Zhengzhou University, Henan Provincial Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China)

机构地区：[1]郑州大学附属儿童医院、河南省儿童医院、郑州儿童医院普外科,450018

出　　处：《中华小儿外科杂志》2018年第12期932-935,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨婴幼儿十二指肠穿孔的原因、诊断及手术方式。方法回顾性分析2010年1月至2017年12月收治的8例婴幼儿十二指肠穿孔患儿的临床资料。其中,男6例,女2例;年龄为(20.3±9.3)个月,年龄范围9~34个月;发病时间为(3.5±1.2)d,时间范围2~6d。术前有典型腹膜炎体征4例。腹部X线平片显示膈下游离气体2例,腹腔穿刺4例均抽出淡绿色肠液。结果本组8例均为单发穿孔,其中十二指肠球部穿孔7例,降部1例。本组行单纯穿孔修补术7例,包括:开腹修补5例,腹腔镜下修补2例。其中,因吻合口瘘二次开腹行胃空肠吻合术1例,行切除穿孔部位肠段行胃十二指肠吻合术1例。8例患儿手术顺利,均痊愈出院。术后切除组织病理检查报告:十二指肠溃疡4例(幽门螺杆菌均为阴性),其余为炎性细胞浸润及坏死组织。本组术后均内科口服奥美拉唑、铝碳酸镁治疗6~8周。4例术后一周左右做13C呼气试验均为阴性。全部患儿获随访,随访时间2个月至7年,8例均未见慢性腹痛等症状,生长发育良好;5例术后行胃镜检查未见溃疡发生。结论婴幼儿十二指肠穿孔病因复杂,溃疡穿孔是其主要原因,非甾体抗炎药(NSAIDs)、激素、化疗药物、全身感染等因素可导致胃肠溃疡发生。婴幼儿十二指肠穿孔常缺乏典型症状体征,腹部X线平片、彩色超声、腹腔穿刺、CT等检查有助于术前诊断。十二指肠修补术是婴幼儿十二指肠穿孔安全、有效的手术方式。Objective To explore the causes, diagnosis and surgical management of duodenal perforation in infants. Methods The medical records were reviewed retrospectively for 8 infants with duodenal perforation from January 2010 to December 2017, There were 6 boys and 2 girls aged (20.3±9.3)(9-34) months. The mean onset time was (3.5±1.2)(2-6) days. Four infants revealed typical signs of peritonitis. Two cases had a large amount of air below both domes of diaphragm on plain abdominal radiography. Diagnostic abdominocentesis yielded slightly green clear liquid in 4 cases. Results Intraoperative inspection revealed one perforation site in all 8 cases. Perforation site was in duodenal bulb (n=7) and descending duodenum (n=1). Operations included primary repair (n=7) (including 5 open repairs, 2 laparoscopic) and duodenal resection & gastroduodenostomy (n=1). One case of anastomotic leak healed after redo gastrojejunostomy (open-repair). All recovered and discharged uneventfully. Postoperative pathological report showed 4 patients had duodenal ulcer (Helicobacter pylori negative) while others had inflammatory cell infiltrate and necrotic tissue. In 4 patients, 13C breath tests were performed postoperatively for H. Pylori and the results were negative. All infants remained healthy without any sequel during a follow-up period of 2 months to 7 years. Five infants were normal under gastroscope. Conclusions The pathogenesis of duodenal perforation is rather complicated in infants. One major cause is peptic ulcer disease. Some drugs, such as nonsteroidal anti-inflammatory drugs or corticosteroids, chemotherapeutic agents and systemic infections are implicated as causative risk factors. Difficulty diagnosis of perforated duodenal ulcer in infants is due to a lack of unconspicuous symptom. It may be improved by plain abdomen radiography, ultrasound, computed tomography and diagnostic abdominocentesis. Simple closure of duodenal ulcer perforation is both safe and effective.

关 键 词：婴幼儿 消化性溃疡 十二指肠 穿孔 

分 类 号：R726.5[医药卫生—儿科]