Wang Li,Huang Liuming,Wang Dayong,et al.Clinical characteristics,diagnoses and treatments of gastrointestinal perforation due to blunt abdominal injury in children[J].Journal of Clinical Pediatric Surgery,2026,(03):285-288.[doi:10.3760/cma.j.cn101785-202305040]
儿童腹部钝挫伤致胃肠道穿孔的临床特点及诊治分析
- Title:
- Clinical characteristics,diagnoses and treatments of gastrointestinal perforation due to blunt abdominal injury in children
- Keywords:
- Contusion; Abdomen; Gastric Perforation; Intestinal Perforation; Surgical Procedures; Operative; Child
- 摘要:
- 目的 总结儿童腹部钝性损伤(blunt abdominal trauma,BAT)致胃肠道穿孔的临床特点、诊治经验及预后情况。方法 回顾性收集2016年1月至2023年1月首都医科大学附属北京儿童医院外科急诊明确诊断的20例BAT致消化道穿孔患儿资料,对致伤原因、临床表现、合并损伤、影像学检查、治疗方式及预后进行归纳分析。结果 20例患儿中男15例、女5例,年龄2岁4个月至12岁6个月,其中>5岁者12例(60%);致伤原因以车祸伤为主(12例,60%),其次为车把伤(4例,20%);多发伤14例(70%),单纯消化道穿孔6例(30%),最常见穿孔部位为小肠(13例,65%)。影像学检查中,腹部B超应用最广泛(19例),阳性率63.2%;行腹立位X线检查8例,阳性4例(50%);腹部CT检查3例,均提示穿孔相关征象。治疗方式包括急诊手术10例、保守治疗后加重转手术6例、保守治疗未手术3例、外院术后转入1例。仅1例合并严重肝外伤患儿因术后肝衰竭死亡,其余19例均预后良好。结论 儿童BAT致胃肠道穿孔多见于5岁以上男孩,车祸伤是主要致伤原因,小肠穿孔最为常见。对BAT患儿尽早完善全面影像学评估、及时明确诊断并选择合适治疗方案,可显著改善预后。
- Abstract:
- Objective To summarize the clinical characteristics,diagnoses,treatments and prognoses of gastrointestinal perforation (GP) due to blunt abdominal trauma (BAT) in children.Methods A retrospective analysis was conducted for the relevant clinical data of 20 GP children due to BAT from January 2016 to January 2023.The causes of injury,clinical manifestations,combined injuries,imaging examinations,treatments and prognoses were examined.Results There were 15 boys and 5 girls with an age range of (28-150) month.Among them,12 cases (60%) were aged over 5 year.The main cause of injury was car accident injury (n=12,60%),followed by handlebar injury (n=4,20%); multiple injuries (n=14,70%) and simple gastrointestinal perforation (n=6,30%).Common perforation site was small intestine (n=13,65%).In imaging examinations,abdominal ultrasound was the most widely used (n=19) with a positive rate of 63.2%; Eight cases underwent abdominal upright radiography with a positive rate of 50%; Three cases of abdominal computed tomography (CT) depicted perforation-related signs.The treatments included emergency surgery (n=10),worsening after conservative measures leading to surgery (n=6),conservative treatment without surgery (n=3) and postoperative transfer from another hospital (n=1).Only one child of severe liver injury died due to postoperative liver failure while the remainders had a decent prognosis.Conclusions Childhood BAT-induced gastrointestinal perforation is more prevalent in boys aged over 5 year.And automobile accident is a leading cause of injury and small intestine perforation predominates.Early and comprehensive imaging evaluation,timely diagnosis and appropriate treatments may significantly improve the prognoses of BAT children.
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备注/Memo
收稿日期:2023-5-24。
基金项目:军委后勤保障部卫生局科技项目(21JZ18)
通讯作者:黄柳明,Email:surhlm@163.com