胃镜辅助经腹壁小切口胃切开术治疗儿童毛发性胃石症  

Guidance of small-incision-gastrotomy by gastroscopy for trichobezoar in children

作　　者：黄一敏[1] 刘江斌[1] 刘海峰[2] 吴伟[1] 吕志宝[1] Huang Yimin;Liu Jiangbin;Liu Haifeng;Wu Wei;Lyu Zhibao(Department of General Surgery,Shanghai Children's Hospital,Shanghai Jiao Tong University, Shanghai 200062,China;Deparment of Gastroenterology,Shanghai Children's Hospital,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院,上海交通大学附属儿童医院普外科,200062 [2]上海市儿童医院,上海交通大学附属儿童医院消化科,200062

出　　处：《中华小儿外科杂志》2019年第1期28-31,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的总结儿童毛发性胃石症的临床特点及胃镜辅助经腹壁小切口胃切开术的手术方法和疗效。方法回顾性分析2013年7月至2016年6月在上海市儿童医院/上海交通大学附属儿童医院收治的5例毛发性胃石症患儿的临床资料,包括:临床表现、影像学检查、手术方法及疗效。结果5例患儿均为女性,年龄为(7±2.5)岁,年龄范围为5~11岁;均有长期吞食毛发史;发病时间为(74±66)d,范围为10~180d。临床表现为反复腹痛4例、呕吐4例、肠梗阻1例,上腹部包块4例。B型超声和CT检查提示胃内异物。经胃镜检查确诊后,因取石失败,行胃镜辅助腹壁小切口胃切开术直视下取石。所取胃石重量约为(1740±1299)g,范围为200~3600g。术后患儿均接受精神疾病专科心理干预及药物治疗。术后随访0.25~2.5年,均未复发。结论毛发性胃石症是儿童罕见的精神障碍性疾病。胃镜检查确诊后,若取石失败,经腹壁小切口胃镜辅助胃切开取石术是一种有效的治疗方法。术后由精神疾病专科进行心理干预和药物治疗以戒除疾病。Objective To summarize the clinical features and curative effect of small-incision-gastrotomy for pediatric patients with trichobezoar at our institution. Methods From July 2013 to June 2016, 5 girls with trichobezoar at Shanghai Children's Hospital/Affiliated Children's Hospital of Shanghai Jiao Tong University were reviewed. The clinical data included clinical manifestations, imaging examinations, surgical procedures and efficacies. Results The average age was (7±2.5)(5-11) years. All cases had a long history of swallowing hair. The average onset time was (74±66)(10-180) days. Clinical manifestations included recurrent abdominal pain (n=4), vomiting (n=4) and intestinal obstruction (n=1). Four patients had a palpable epigastric mass. Ultrasound and computed tomography (CT) revealed foreign bodies. All definite diagnoses were made by gastroscopy followed by small-incision-gastrotomy guided by gastroscopy. The weight of gastric stone was (1 740±1 299)(200-3 600) grams. After operation, all children received psychological interventions and medications. During a mean follow-up period of (1.0±0.75)(0.25-2.5) years, there was no recurrence. Conclusions As a rare disease, trichobezoar is caused by obsessive-compulsive disorder in children. Endoscopy is a gold diagnostic standard. Small-incision-gastrotomy guided by gastroscopy is an effective treatment for the disease. Postoperative patients should be treated by psychologist to avoid recurrence.

关 键 词：胃肠结石 异食癖 剖腹术 胃镜检查 

分 类 号：R726.5[医药卫生—儿科]