先天性胃壁肌层缺损致胃穿孔8例的临床分析  

Clinical Analysis of 8 Cases of Gastric Perforation Caused by Congenital Gastric Wall Muscle Defect

作　　者：何朝升[1] 苏毅[1] 胡增隆 刘明学[1] HE Chao-sheng;SU Yi;HU Zeng-long;LIU Ming-xue(Department of Pediatric Surgery,the First Affiliated Hospital of Xiamen University,Xiamen,Fujian Province,361000 China)

机构地区：[1]厦门大学附属第一医院小儿外科,福建厦门361000

出　　处：《中外医疗》2020年第5期22-24,共3页China & Foreign Medical Treatment

基　　金：福建省自然科学基金项目资助(2019J01564)。

摘　　要：目的结合回顾性调查分析,更加深入的了解先天性胃壁肌层缺损致胃穿孔患儿的临床特点,并掌握治疗预后,以期提高该类患儿的诊疗水平。方法对厦门大学附属第一医院小儿外科2010年3月-2019年3月来收治的先天性胃壁肌层缺损致胃穿孔8例患儿临床资料进行系统地回顾性调查分析。结果该组男6例,女2例。平均出生体重1.84 (1.05~3.15) kg;3例为顺产,5例为剖宫产;6例为早产儿伴低出生体重儿,2例为足月儿。为出生后1~4 d发现消化道穿孔。8例患儿存在哭闹、腹胀、呕吐及呼吸困难症状。1例患儿表现为消化道出血,7例患者出现肛门停止排便、排气或仅排少量肠液样粘液便。1例合并腹腔型隐睾,2例合并肠旋转不良。患者均进行病变组织切除+胃壁修补缝合+腹腔引流术。1例腹腔型隐睾行睾丸下降固定+疝囊高位结扎术,2例合并肠旋转不良患儿加行Ladd’s手术。1例合并有回肠闭锁,给予行回肠造口术,生后6个月二期行回肠还纳手术。8例患儿中,7例患儿存活,随访6~12个月, 1例患儿存在胃食管反流,通过有效的治疗,其症状得到了改善,饮食及排便基本正常。1例死亡,病死率为12.5%。死亡原因为DIC合并肺出血。结论对于新生儿来说,先天性胃壁肌层缺损对其影响较大,威胁患儿生命安全。因此临床必须尽早确诊,然后立刻进行手术探查,将病变组织切除,促进患儿身体康复。在此过程中,还需结合围手术期治疗,如抗感染、抗休克及营养支持等,保证患儿获得良好的预后。Objective To analyze the clinical features of children with gastric perforation caused by congenital gastric wall muscle defect and to understand the prognosis of patients with gastric perforation due to retrospective investigation and analysis, in order to improve the diagnosis and treatment of this type of children. Methods The clinical data of 8 cases of gastric perforation caused by congenital musculus defect of gastric wall admitted to the department of pediatric surgery of the first affiliated hospital of Xiamen university from March 2010 to March 2019 were retrospectively investigated and analyzed. Results There were 6 males and 2 females in this group. The average birth weight was 1.84(1.05 ~3.15) kg;3 cases were due to delivery, 5 cases were cesarean section;6 cases were premature infants with low birth weight and 2 cases were full-term children. Digestive tract perforation was found 1 to 4 days after birth. Eight patients had symptoms of crying,bloating, vomiting, and difficulty breathing. One patient presented with gastrointestinal bleeding, and 7 patients developed anal cessation of bowel movements, venting, or only a small amount of intestinal fluid-like mucus. One patient had abdominal cryptorchidism and two patients had intestinal malrotation. All patients underwent lesion resection + stomach wall repair suture + abdominal drainage. One case of abdominal cryptorchidism was treated with testicular descending +high sac ligature ligation, and two patients with intestinal dysplasia were treated with Ladd’s. One patient had ileal atresia combined with ileostomy, and the ileum was resected 6 months after birth. Of the 8 patients, 7 survived and were followed up for 6 to 12 months. One patient had gastroesophageal reflux. Through effective treatment, the symptoms were improved and the diet and bowel movements were basically normal. One patient died and the case fatality rate was 12.5%. The cause of death was DIC with pulmonary hemorrhage. Conclusion For neonates, the congenital gastric wall muscle defec

关 键 词：先天性胃壁肌层缺损 胃穿孔 早产儿 

分 类 号：R726[医药卫生—儿科]