小儿肠系膜裂孔疝致肠坏死危险因素分析  

Analysis of risk factors for bowel necrosis induced by mesenteric hiatal hernia in children

作　　者：龚晟[1] 何吉哲[1] 诸建明[1] 

机构地区：[1]宁波市妇女儿童医院小儿外科,浙江宁波315012

出　　处：《中国现代医生》2016年第29期94-97,共4页China Modern Doctor

基　　金：宁波市科学技术局项目(2014B82003)

摘　　要：目的总结小儿肠系膜裂孔疝诊治的临床经验,分析小儿肠系膜裂孔疝导致肠坏死的危险因素。方法回顾性分析2007年1月~2016年1月我院收治的24例肠系膜裂孔疝患儿病例资料。结果 所有肠系膜裂孔疝患儿均为单发孔,其中空肠系膜裂孔2例,回肠系膜裂孔17例,结肠系膜裂孔5例。18例出现肠坏死。术后所有患儿恢复良好。小儿肠系膜裂孔疝导致肠坏死的危险因素是发病时间〉12 h,收缩压〈70 mm Hg且脉压〈20 mm Hg,血红蛋白〈8 g/d L,肠系膜裂孔直径〈3 cm,差异有统计学意义（P〈0.05）。结论 先天性肠系膜裂孔疝早期诊断困难,容易发生肠坏死。肠坏死的发生和患儿的年龄,体温,腹腔内积液的量,疝入肠管的长度并无统计学上的关系。而与患儿的发病时间,血压与脉压,血红蛋白和肠系膜裂孔的直径有一定的关联。尽早诊断并及时手术对于避免更多肠管的坏死,菌血症和中毒性休克的发生,降低患儿死亡率有积极意义。Objective To summarize the clinical experiences of treatment and diagnosis of bowel necrosis induced by mesenteric hiatal hernia in children, and to analyze the risk factors for bowel necrosis induced by mesenteric ＇hiatal her- nia in children. Methods The clinical data Of 24 admitted patients with mesenteric hiatal hernia in our hospital from January 2007 to January 2016 were retrospectively analyzed. Results Single mesenteric hiatal was observed in ali pa- tients. Among them, 2 patients were jejunal mesentery hiatal, 17 patients were ileal mesentery hiatal, and 5 patients were colonic mesentery hiatal. Bowel necrosis was observed in 18＇ patients~ The recovery was favorable in all children patients after the surgery. Duration of disease more than 12 hours, systolic pressure less than 70 mmHg and pulse pres- sure less than 20 mmHg, hemoglobin less than 8 g/dL and the diameter of mesenteric hiatal less than 3 cm were the re- lated factors for the bowel necrosis induced by mesenteric hiatal hernia in children, and the differences were statistically significant（P〈0.05）. Conclusion Early diagnosis of congenital mesenteric hiatal hernia is difficult, which may lead to intestinal necrosis. The occurrence of intestinal necrosis has no statistical relationship with children＇s age, temperature, the volume of ascites and the length of intestinal necrosis, but has certain relationship with the duration of disease, blood pressure, pulse pressure, hemoglobin and diameter of the ceasma. Early diagnosis and timely surgery can reduce the incidence rate of bowel necrosis, bacteremia and toxic shock, which is of positive significance in decreasing the mortality of children.

关 键 词：儿童 肠系膜 疝 外科手术 

分 类 号：R726.5[医药卫生—儿科]