Niu Huizhong,Zhang Pengju,Liu Feng,et al.Analysis of acute gastrectasia in children[J].Journal of Clinical Pediatric Surgery,2019,18(10):888-892.[doi:10.3969/j.issn.1671-6353.2019.10.018]
小儿急性胃扩张治疗效果分析
- Title:
- Analysis of acute gastrectasia in children
- 分类号:
- R726;R573
- 摘要:
- 目的 探讨小儿急性胃扩张临床特点，提高对儿童急性胃扩张的认识。方法 回顾性分析2009年12月至2017年8月由河北省儿童医院收治的8例小儿急性胃扩张患儿临床资料，总结其临床表现及治疗方法，并进行文献复习。8例患儿中，男童2例，女童6例；年龄11个月18 d至5岁3个月，平均年龄2岁6个月；临床表现以呕吐、腹痛、腹胀为主。X线检查均可见胃泡扩张。8例中6例患儿经保守治疗，保守治疗主要措施为持续胃肠减压、液体复苏、体位治疗及营养支持；2例经手术治疗。结果 6例经保守治疗后症状恢复。2例手术患儿，1例经探查为胃破裂，1例为合并膈膨升，均经手术治愈。8例患儿均获随访。最长随访时间为5年，最短随访时间为1个月，生长发育无异常。结论 急性胃扩张在婴幼儿及儿童中少见，其临床表现以呕吐、腹痛、腹胀为主，大部分患儿可以通过非手术治疗治愈，部分患儿保守治疗无效时，需尽快行手术治疗。选择合理的诊疗方式有助于改善患儿预后。
- Abstract:
- Objective To explore the clinical features of acute gastrectasia of children.Methods Retrospective analysis was performed for clinical data of 8 children of acute gastrectasia from December 2009 to August 2017.Clinical manifestations and treatments of the disease were summarized with a literature review.There were 2 boys and 6 girls with an average age of 30(11.6-63) months.All cases demonstrated gastrectasia on radiographic film.Results Two cases were operated for gastric rupture and elevated diaphragm respectively while the remainder received conservative measures.The major measures of conservative treatment were continuous gastrointestinal decompression,fluid resuscitation and nutritional support.All cases survived and successfully recovered.The maximal follow-up period was 5 years and the shortest 1 month.Both growths and developments were normal.Conclusion Acute gastric distension is rare in infants and toddlers. Its predominant clinical manifestations include vomiting and abdominal pain/fullness. Most children may be cured through non-surgical measures. Those not responding to conservative measures should be operated as soon as possible. Selecting rational diagnostics and therapeutics help boost the patient outcomes.
参考文献/References:
1 张喜春.急性胃扩张1例治疗分析[J].中外医学研究,2011,9(2):81.DOI:10.3969/j.issn.1674-6805.2011.02.060. Zhang XC.Treatment analysis of one case of acute gastrectasia[J].Chinese & Foreign Medical Research,2011,9(2):81.DOI:10.3969/j.issn.1674-6805.2011.02.060.
2 秦士博,刘站站,杨腾飞.急性胃扩张28例诊治分析[J].中国实用外科杂志,2014,34(1):38-39. Qin SB,Liu ZZ,Yang TF.Diagnosis and treatment of acute gastrectasia:a report of 28 cases[J].Chin J Appl Chin Pediatr,2014,34(1):38-39.
3 Badamutlang D,Chandra BS,Mohd S.Acute gastric dilatation with necrosis and perforation:case report of a 16 year old girl[J].Indian J Surg,2013,75(Suppl 1):S180-S181.
4 马艳波,赵浩亮,刘建生.急性胃扩张9例诊治体会[J].中国药物与临床,2008,8(7):566-567.DOI:10.3969/j.issn.1671-2560.2008.07.024. Ma YB,Zhao HL,Liu JS.Experiences of diagnosing and treating acute gastrectasia[J].Chinese Remedies & Clinics,2008,8(7):566-567.DOI:10.3969/j.issn.1671-2560.2008.07.024.
5 张金哲,潘少川,黄澄如.实用小儿外科学[M].杭州:浙江科学技术出版社,2003:691. Zhang JZ,Pan SC,Huang CR.Practical Pediatric Surgery[M].Hangzhou:Zhejiang Science & Technology Press,2003:691.
6 Todd SR,Marshall GT,Tyroch AH.Acute gastric dilatation revisited[J].American Surgeon,2000,66(8):709-710.
7 张金哲.小儿外科学[M].北京:人民卫生出版社,2013:1156. Zhang JZ.Pediatric Surgery[M].Beijing:People’s Medical Publishing House,2013:1156.
8 屈双权,张溪英.与术前注射阿托品相关的急性胃肠扩张1例[J].临床小儿外科杂志,2006,5(2):159.DOI:10.3969/j.issn.1671-6353.2006.02.030. Qu SQ,Zhang XY.One case of acute gastrectasia relative to application of atropine before operation[J].J Clin Ped Sur,2006,5(2):159.DOI:10.3969/j.issn.1671-6353.2006.02.030.
9 Adson D,Mitchell JE,Trenkner SW.The superior mesenteric artery syndrome and acute gastric dilatation in eating disorders:A report of two cases and a review of the literature[J].Int J Eat Disord,1997,21(2):103-114.
10 Stheneur C,Rey C,Pariente D,et al.Acute gastric dilatation with superior mesenteric-artery syndrome in a girl with anorexia-nervosa[J].Arch Pediatr,1995,2(10):973-976.DOI:10.1016/0929-693X(96)89893-9.
11 Nam K,Shin HD,Shin JE.Acute gastric dilatation and ischemia associated with portal vein gas caused by binge eating[J].Korean J Intern Med,2019,34(1):231-232.DOI:10.3904/kjim.2017.050.
12 Kim AY,Jung SY,Eun LY.Life-threatening acute gastric dilatation with aorta compression in a 3-year-old child[J].Pediatrics International,2015,57(6):1184-1186.DOI:10.1111/ped.12714.
13 罗海军,陈威时.急性胃扩张并左侧膈肌破裂一例[J].广东医药,2000,21(10):846.DOI:10.3969/j.issn.1001-9448.2000.10.067. Luo HJ,Chen WS.One case of acute gastrectasia with left diaphragmatic rupture[J].Guangdong Medical Journal,2000,21(10):46.DOI:10.3969/j.issn.1001-9448.2000.10.067.
14 Sahoo MR,Kumar AT,Jaiswal S,Bhujabal SN.Acute dilatation,ischemia and necrosis of stomach without perforation[J].Case Rep Surg,2013,2013:984594.DOI:10.1155/2013/984594.
15 Kocaoglu C,Akillioglu I,Gunduz M,et al.Unexpected death due to acute gastric dilatation and gastric necrosis in an 11-year-old boy[J].Pediatr Emerg Care,2017,33(11):e131-e133.DOI:10.1097/PEC.0000000000000699.
备注/Memo
收稿日期:2018-05-01。
通讯作者:陈亚军,Email:chenyajunmd@aliyun.com