腹腔镜下穿孔修补术治疗儿童胃十二指肠穿孔  

Laparoscopic repair of perforated gastroduodenum in children

作　　者：叶国刚[1] 段栩飞[2] 周诗琼[2] 刘江斌[1] 吕志宝[1] 孙烜[2] 杨虎[2] 

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]武汉市儿童医院

出　　处：《中华小儿外科杂志》2015年第11期805-809,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨儿童胃十二指肠穿孔的病因，总结腹腔镜胃十二指肠穿孔修补术治疗儿童胃十二指肠穿孔经验。方法回顾性分析2009年1月至2015年6月12例儿童胃十二指肠穿孔的临床病理资料，其中男9例，女3例，年龄4岁3个月至15岁9个月，中位年龄12岁。结果4例为H．pylori感染所致，2例为应用免疫抑制剂如激素类药物引起，1例为应用非甾体类抗炎药物所致，1例为白血病化疗期间发生，1例为胃内毛团引起，1例为全身严重感染引起，2例未找到明确病因。12例患儿中10例于手术中顺利找到穿孔部位并完成腹腔镜下穿孔部位修补术，2例中转开腹，穿孔位于胃窦、十二指肠部10例，胃体部1例，胃底部1例；穿孔直径大小4～12mm，平均6．1mm，手术时间28～125min，平均52min。术后病理检查均未见癌前病变或癌组织，无异位胰腺等组织，所有患儿均痊愈出院，无吻合口漏、肠梗阻及伤口感染等术后并发症，住院时间5～8d，平均6．2d。随访时间7个月至6年，未见再次穿孔，无贫血、营养不良及腹痛、呕吐等肠粘连肠梗阻等表现。结论药物（激素、非甾体类抗炎药物及化疗药物）、幽门螺旋杆菌感染是引起儿童胃十二指肠穿孔的主要病因；腹腔镜下穿孔修补术治疗儿童胃十二指肠穿孔可行、安全、有效。Objective To explore the etiology of pediatric gastroduodenal perforation and summarize the experiences of laparoscopic repair for pediatric gastroduodenal perforation. Methods The clinical data were reviewed for 12 children with gastroduodenal perforation from January 2009 to June 2015. There were 9 males and 3 females with a median age of 12 years. Results The causes were H. pylori infection （n = 4）, use of hormones （n = 2）, use of non-steroidal anti-inflammatory agent （n = 1）, leukemia during chemotherapy （n = 1）, gastric trichobezoar （n = 1）, serious systemic infections （n = 1 ） and unknown etiology （n = 2）. Intraoperatively perforation sites were found successfully in 10 cases of laparoscopic repair. Two cases were converted into laparotomy. The perforation site were located in gastric antrum and duodenum （n = 10）, gastric body （n = 1 ） and gastric fundus （n = 1）. The average diameter was 6. 1 （4-12） mm and average operative duration 52 （28-125） min. Postoperative pathology showed no precancerous or cancerous tissue. Neither heterotopic pancreas nor other tissues was found. All of them were cured and discharged postoperatively. There was no occurrence of anastomotic leak, bowel obstruction, wound infection or other surgical complications. The average hospitalization time was 6. 2（5-8） days. Re-perforation, anemia, malnutrition, abdominal pain, vomiting and other symptoms due to intestinal adhesion or intestinal obstruction were absent during a follow-up period of 7 months to 6 years. Conclusions Hormones, non-steroidal anti- inflammatory agents, chemotherapeutic drugs and helicobacter pylori infection are the most common causes of gastroduodenal perforation in children. And laparoscopic repair is feasible, safe and effective.

关 键 词：消化性溃疡 肠穿孔 腹腔镜 儿童 

分 类 号：R726.5[医药卫生—儿科]