小儿肠系膜裂孔疝29例临床分析  

Clinical analysis of 29 cases of mesenteric hernia in children

作　　者：高春桃[1] 李小松[1] 

机构地区：[1]首都医科大学附属北京儿童医院,北京市100045

出　　处：《临床小儿外科杂志》2016年第1期76-79,90,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的总结小儿先天性肠系膜裂孔疝的临床经验,探讨小儿先天性肠系膜裂孔疝的临床特点及治疗方法。方法回顾性分析2007年2月至2014年2月我们收治的29例肠系膜裂孔疝患儿病例资料。结果入院时患儿临床表现:呕吐26例,腹痛22例,腹胀11例,停止排气排便7例,血便2例;伴休克前期或休克4例,伴腹膜炎3例;腹腔穿刺为血性腹水9例。术前即高度怀疑肠系膜裂孔疝或腹内疝10例;术前诊断机械性肠梗阻11例;术前不明确诊断4例;术前误诊为其他疾病4例;其中多发裂孔疝2例。上述病例中致肠缺血坏死23例,其中19例行肠切除肠吻合术,4例行肠外置术。结论先天性肠系膜裂孔疝早期诊断困难,极易误诊、漏诊,导致肠缺血坏死,严重者将丢失大量肠管,甚至造成短肠综合征。对于疑似病例,应早期手术探查,术中根据肠管缺血情况行肠管复位术、肠切除肠吻合术或肠外置术。Objetive To explore the clinical characteristics,diagnosis, and treatment of congenital mesenteric hiatal hernia in children including pathogenesis, by studying 29 clinical cases. Methods A retrospective analysis was conducted on the clinical data of 29 hospitalized patients with congenital mesenteric hiatal her-nia in our hospital from Feb. 2007 to Feb. 2014. Results In all patients, the major clinical symptoms include vomiting in 26 cases, abdominal pain in 22 cases, abdominal distention in 11 cases, the absence of exhaust and defecate in 7 cases, bloody stool in 2 cases. Moreover,4 cases complicated with hypovolemic shock,3 cases with peritonitis ,9 cases with bloody ascites by abdominal puncture. Among these 29 patients, 10 cases were highly suspected mesentcric hiatal hernia preoperatively, 11 cases were diagnosed as intestinal mechanical obstruction at emergency. No definitive diagnoses were given in 4 cases, whereas other 4 cases were misdiagnosed preopera- tively. Multiple mesenteric hiatal happened in 2 cases. 23 cases were demonstrated intestinal ischemic necrosis during operation ,in which 19 cases implemented intestinal resection and anastomosis and 4 cases did intestinal exteriorization. Conclusions Early diagnosis of congenital mesenteric hiatal hernia is difficult. Delayed diagnosis might lead to intestinal ischemia and necrosis, even resulting in short bowel syndrome. For suspected patients, early exploratory operation should be preformed to avoid massintestine lose. Intestinal reposition, resection and anastomosis or intestinal exteriorization were chosen according to intestinal status.

关 键 词：肠系膜 疝 外科手术 治疗结果 儿童 

分 类 号：R726.5[医药卫生—儿科]