13例新生儿胃穿孔诊治结果分析  

Clinical diagnosis and treatment of neonatal gastric perforation: a report of 13 cases

作　　者：黄雄[1] 陈发玲 盛庆丰[1] 吴一波[1] 孙俊 徐伟珏[1] Huang Xiong;ChenFaling;Sheng Qingfeng;Wu Yibo;Sun Jun;Xu Weijue(Department of General Surgery,Affiliated ShanghaiChildren＇s Hospital,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海交通大学附属儿童医院普外科,上海市200062

出　　处：《临床小儿外科杂志》2018年第11期858-861,共4页Journal of Clinical Pediatric Surgery

摘　　要：目的总结13例新生儿胃穿孔的临床特点和治疗经验。方法以2010年9月至2016年12月上海交通大学附属儿童医院普外科和新生儿科收治并行手术治疗的13例胃穿孔患儿为研究对象,收集患儿性别、胎龄、出生体重、首发症状、手术方式、手术效果及预后等临床资料,通过对上述资料的整理分析评估治疗效果。结果 13例患儿中,生存12例(92. 31%),死亡1例(7. 69%)。低出生体重7例(53. 85%);早产儿9例(69. 23%);术前X线片显示气腹13例(100%);术前血气分析显示酸中毒(p H <7. 35) 8例(61. 54%);胃穿孔长度小于2 cm者2例(15. 38%),2～5 cm者6例(46. 15%),大于5 cm者5例(38. 46%);发病日龄均为出生后1周以内,出现症状到手术时间间隔<24 h者11例(84. 61%),≥24 h者2例(15. 29%,1例死亡);穿孔部位:胃前壁3例(23. 08%),胃后壁2例(15. 29%),胃大弯5例(38. 46%),胃小弯2例(15. 29%),同时位于胃前壁及胃后壁1例(7. 69%,为死亡病例); 13例均行一期胃壁修补手术,术后胃壁肌层缺损9例(69. 23%),胃壁肌层发育不良1例(7. 69%),缺血坏死3例(23. 08%)。结论从本次纳入的13例新生儿诊治分析结果来看,新生儿胃穿孔多发生于早产儿、低出生体重儿;穿孔部位多位于胃前壁及胃大弯;胃壁肌层缺损为新生儿胃穿孔首要病因。积极的围产期管理、原发疾病的早期治疗及纠正消化道合并畸形对改善患儿预后有重要的临床意义。Objective To summarize our experience of clinical diagnosis and treatment of neonatal gastric perforation （NGP）. Methods The clinical data were retrospectively analyzed for 13 NGP neonates undergoing surgical interventions from September 2010 to December 2016. The clinical data included gender,gestational age,weight,symptom onset,surgical approaches and patient outcomes. Results Among them,there were7 lowbirthweight cases （53. 85%） and 9 preterm neonates （69. 23%）. Radiography indicated pneumoperitoneum in all patients. Blood gas analysis revealed acidosis （PH 〈 7. 35） （n = 8,61. 54%）. Perforation length was 〈2 cm （n = 2,15. 38%）,between 2 to 5 cm （n = 6,46. 15%） and 〉 5 cm （n = 5,38. 46%）. All symptoms appeared within 1 week after birth. According to time from symptoms to surgery,11 cases （n = 11,84. 61%） were〈 24 h and the remainder （n = 2,15. 29%） 〉 24 h （one case of mortality）. The sites of perforation were locatedon anterior gastric wall （23. 08%）,posterior gastric wall （n = 2,15. 29%）,greater curvature （n = 5,38. 46%）,lesser curvature （n =2,15. 29%） and anterior ＆ posterior gastric walls （n = 1,7. 69%）. All 13 patients were operated with a survival rate of 92. 31% （12 / 13）. Pathological examinations revealed gastric musculature defects （n= 9,69. 23%）,gastric myometrial dysplasia （n = 1,7. 69%） and ischemic necrosis （n = 3,23. 08%）. Conclusion NGP occurs frequently in preterm and lowbirthweight neonates. Anterior gastric wall and greater curvatureare common perforation positions. Gastric musculature defect is a leading cause of NGP. Active perinatal management,early treatment of primary disease and digestive tract malformation improve patient outcomes.

关 键 词：新生儿 胃穿孔 消化道畸形 外科手术 预后 

分 类 号：R726.5[医药卫生—儿科]