儿童消化道出血病因的临床与病理研究  

Study on clinical and pathology of children with gastrointestinal bleeding

作　　者：徐樨巍[1] 王惠玲[1] 申芳娥[1] 

机构地区：[1]首都医科大学附属北京儿童医院内科,北京100045

出　　处：《实用儿科临床杂志》2004年第6期487-489,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的　分析儿童消化道出血 (GIB)的病因 ,了解其临床与病理检查结果的关系。方法　对 15 3例GIB患儿进行胃镜或结肠镜及其相应病理学等检查 ,包括幽门螺杆菌 (Hp)检测。 结果　明确病因 14 0例 ,确诊率 91.5 % ,上、下消化道出血 (UGIB、LGIB)分别为 74例和 6 6例。胃病理检查 5 6例 ,均显示慢性浅表性胃炎(CSFG) ,Hp(+) 33例。炎症组与溃疡组Hp(+)检出率有显著差异 (P <0 .0 5 )。对轻、中、重度炎症Hp(+)检出率进行比较 ,3组均有显著差异 (P均 <0 .0 5 )。LGIB前 3位病因依次为结、直肠息肉、梅克尔憩室和肠重复畸形。LGIB 6 6例中 ,病理证实 6 4例 (97% )。结论　儿童UGIB以十二指肠溃疡 (DU)并CSFG多见 ,溃疡组Hp感染率高于炎症组 ,且胃部炎症越严重 ,Hp感染率越高。LGIB以结、直肠息肉多见。小肠部位的肠系膜及肠壁血管瘤少见 ,且经常规检查不易确诊。Objective To evaluate the etiologies of children with gastrointestinal bleeding(GIB), and the relationship between the pathological findings and clinical.Methods Gastroscopy or proctoscope was performed in 153 children with GIB. Pathological studies and tests as for helicobactor pylori (Hp) were undertaken.Results Among 153 children,140 cases(91.5 %) had definite diagnosis,including 74 children with upper gastrointestinal bleeding(UGIB) and 66 cases with lower gastrointestinal bleeding(LGIB). Gastric pathologic study was conducted in 56 cases. All patients had chronic superficial gastritis(CSFG). Hp test was positive in 33 patients. There was significant difference in the positive rate of Hp test between patients with gastritis or duodenitis and those with ulcers (P<0.05). There were differences among patients with mild, moderate of severe inflammation in the positive rates of Hp test ( P<0.05). The first 3 most common etiologies of LGIB were colonic or rectal polypi, Meckel diverticulum, intestine duplication respectively. Sixty-four cases(97 %) were confirmed by pathological study.Conclusions Duodenal ulcer(DU) complicated with CSFG is the commonest etiology of UGIB in children. The positive rates of Hp test are high in patients with peptic ulcer disease, and in those with severe inflammation. Colonic or rectal polypi is the common reasons for LGIB. Intestine and mesentery hemangioma seems to be rare and not easy to diagnose by routine examination.

关 键 词：儿童 消化道出血 临床 病理 幽门螺杆菌 

分 类 号：R725.7[医药卫生—儿科]