自闭症儿童急腹症的外科治疗  

Surgical management of acute abdomen in children with autism

作　　者：吴晓娟[1] 余克驰[1] 翁一珍[1] 夏雪[1] 冯杰雄[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院小儿外科,武汉430032

出　　处：《中华小儿外科杂志》2014年第12期933-935,共3页Chinese Journal of Pediatric Surgery

基　　金：国家临床重点专科建设项目[国卫办医函（2013）544号]

摘　　要：目的探讨自闭症儿童急腹症的特点及治疗经验。方法回顾性分析2011年6月至2013年1月收治的3例自闭症儿童急腹症的临床表现，包括发病时间、起病症状、体征、辅助检查，术中情况及术后恢复情况。结果3例患儿从发病（家属发现的客观症状）至我院就诊的时间分别为7h、3d和20余天，住院后手术的时间分别为5h、1d和2d。主诉包括呕吐、行为改变及弯腰行走，1例停止排气排便，2例出现腹泻，3例均伴发热。体格检查不配合，对疼痛不敏感，1例出现拒按腹部的行为，1例腹胀。3例血常规白细胞计数升高（10．3～17．2×10^9／L），以中性粒为主（69．0％～88．9％）。1例腹部X线平片检查有液气平；2例腹部B型超声检查有积液，无包块。3例均行手术探查。2例行腹腔镜探查，1例中转开腹；1例剖腹探查。1例为急性阑尾炎并穿孔，1例为阑尾周围脓肿并肠梗阻，1例为梅克尔憩室化脓并穿孔。术后恢复均顺利，5～9d出院。结论自闭症儿童发生急腹症时，主观症状，如腹痛不明显，而以客观行为为主；主诉时间与病情不符合，明显延迟；体检不合作，诊断困难，误诊率高，容易延误手术时机。一旦有手术指征立即手术，避免耽误病情，引起严重后果。及时手术治疗可取得满意疗效。Objective To summarize the clinical characteristics and treatment experiences of acute abdomen in autistic children. Methods Retrospective analyses were performed for 3 autistic children of acute abdomen during the period of June 2011 and January 2013. The relevant clinical characteristics included disease duration, onset of symptoms, signs, accessory examinations, tentative diagnosis, intraoperative findings and postoperative recovery. Results The onset periods were 7 hours, 3 days and 20 days respectively. The clinical symptoms included vomiting, behavioral changes and walking stooped. There were no flatus or constipation （n = 1）, diarrhea （n = 2） and fever （n = 3）. Physical examination was non-cooperative. There were abdominal distension （n = 1 ）, abdominal muscle guarding （n = 1） and resistance to abdominal pressing （n = 1） because of insensitivity to pain. White blood cells were all elevated （10. 3-17. 2×10^9/L）. Liquid-gas plane was present on X-ray in 1 case and type B ultrasound showed abdominal effusion in 2 cases. All underwent surgical exploration including 2 laparoscopic procedures. One case was intraoperatively diagnosed as acute appendicitis with perforation, was another as appendiceal abscess ＆ intestinal obstruction and a third as Meckel＇s diverticulum suppuration ＆ perforation. All recovered well after operation. Conclusions For acute abdomen in children with autism, objective behaviors are more important than subjective symptoms. There is some gap between patient conditions and complaint time. A preoperative diagnosis is often rather difficult. For avoiding delayed treatment, emergency operation is required when surgical indications arise. Timely surgery may achieve satisfactory outcomes.

关 键 词：急腹症 精神障碍 儿童期诊断的 消化系统外科手术方法 

分 类 号：R749.94[医药卫生—神经病学与精神病学]