婴幼儿重症急性胃扩张的临床特点及诊治体会  

Clinical characteristics and therapeutic strategies of severe acute gastric dilatation in infants

作　　者：冯欣[1] 侯广军 耿宪杰 张现伟 郜向阳[1] 周良 韦源[1] Feng Xin;Hou Guangjun;Geng Xianjie;Zhang Xianwei;Gao Xiangyang;Zhou Liang;Wei Yuan(Department of General Surgery, Affiliated Children's Hospital, Zhengzhou University, Zhengzhou 450018, China)

机构地区：[1]郑州大学附属儿童医院普外科,450018

出　　处：《中华小儿外科杂志》2019年第8期719-722,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨婴幼儿重症急性胃扩张的临床特点及治疗体会。方法回顾性分析2010年1月至2017年1月郑州大学附属儿童医院普外科收治的25例婴幼儿重症急性胃扩张的临床资料,综合分析其临床特征、诊治经过和预后情况,探讨婴幼儿重症急性胃扩张的有效诊治措施。25例患儿中,男12例,女13例,年龄4~36个月,年龄(13.1 ± 1.1)个月,其中4~12个月13例。临床表现为剧烈非胆汁样呕吐和剧烈腹胀,其中伴发热22例(88.0%),重度脱水16例(64.0%);神智改变16例(64.0%),休克16例(64.0%);呼吸功能不全5例(20.0%);腹肌紧张4例(16.0%)。急性胃扩张患儿因急腹症行手术治疗4例,其中胃穿孔修补术3例,胃穿孔修补、胃造口术1例。1例患儿因保守治疗无效行胃造口术。非手术治疗20例,除抗休克治疗外,主要治疗措施为禁食水、持续胃肠减压、肠外营养,伴高热、脓毒血症的患儿同时应用广谱抗生素。大部分患儿胃肠减压时间在7 d以上,仅3例患儿胃肠减压不彻底(5 d),胃扩张复发,再次留置胃管5 d后痊愈。结果出院后常规随访6个月,除1例合并黏多糖淤积症Ⅱ型多次复发,最终因胃破裂死亡外,其余均未见复发。结论婴幼儿重症急性胃扩张病程进展快,易合并呼吸循环障碍,早期诊断治疗,预后好;保守治疗时胃肠减压时间应足够长,以利于胃形态及功能恢复,防止复发及并发症发生;经保守治疗效果不佳或有明显腹膜炎体征的应积极行手术治疗。Objective To summarize the clinical features and therapeutic experiences of severe acute gastric dilatation (AGD) in infants. Methods Clinical data were retrospectively reviewed for 25 AGD patients from January 2010 to January 2017. Their clinical features and treatment options were comprehensively analyzed. There were 12 boys and 13 girls with an age of (13.1±1.1)(1/3-3) years. Thirteen cases were aged from 4 to 12 months. The clinical symptoms were non-typical with vomiting and severe abdominal distention as two major clinical manifestations. And the accompanied manifestations included fever (88.0%), severe dehydration (64.0%), neurologic symptoms (64.0%), shock (64.0%), respiratory insufficiency (20.0%) and muscular spasm (16.0%). Four cases of acute penitonitis underwent emergency repairing of gastric perforation alone (n=3) and plus gastrostomy (n=1). One infant underwent gastrostomy after a failure of conservative measures. Twenty cases received anti-shock measures, water fasting, gastrointestinal decompression, perenteral nutrition and application of antibiotics. The duration of gastrointestinal decompression was >7 days in most infants. Three infants recurred due to an insufficiency of gastrointestinal decompression and were cured by gastrointestinal decompression again. Results Follow-ups lasted for up to 6 months. Except for one recurrent case of mucopolysaccharidosis, the remainder were healed. Conclusions Acute gastric dilatation progresses rapidly with respiratory insufficiency and disturbance of blood circulation in infants. Early diagnosis and treatment can improve the prognosis of AGD. AGD patients should receive adequate conservative treatment facilitating the recovery of gastric function and preventing the recurrence and complications. Once conservative therapy fails or typical signs of peritonitis are present, aggressive surgical interventions should be ideal.

关 键 词：胃扩张 婴儿 治疗 

分 类 号：R726.5[医药卫生—儿科]