小儿肠系膜裂孔疝病例特点的临床研究

发布时间：2018-01-12 11:12

本文关键词：小儿肠系膜裂孔疝病例特点的临床研究　出处：《首都医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:结合临床病例,对小儿先天性肠系膜裂孔疝的临床病例特点进行分析。方法:回顾性分析我院外科2007年2月—2016年2月间住院治疗,并经手术证实为肠系膜裂孔疝者38例,对上述病例的临床资料进行分析探讨。结果:入院时患儿的临床表现:呕吐35例,腹痛30例,腹胀20例,发热19例,停止排气排便14例,血便2例,伴休克前期或休克者9例,伴腹膜炎者8例,其中15例行腹腔穿刺均为血性腹水或者不凝血。术前诊断肠系膜裂孔疝5例,绞窄性肠梗阻或腹内疝10例,机械性肠梗阻15例,不明确诊断6例,其他诊断2例;多发裂孔有2例。上述病例中致肠缺血坏死31例,其中26例行肠切除肠吻合术,5例行肠外置术。结论:先天性肠系膜裂孔疝早期诊断困难,极易误诊、漏诊,导致肠缺血坏死,严重者将丢失大量肠管,甚至造成短肠综合征。对于疑似病例,应早期手术探查,根据X线诊断肠梗阻,可有“固定无蠕动肠襻”以及“假肿瘤”征,B超可探查肠管血运情况及肠系膜、肠壁水肿增厚改变,必要时腹腔穿刺,为早期手术干预提供理论依据;肠管坏死与肠系膜位置、嵌顿时间无明显相关性,肠坏死对应肠系膜裂孔直径多集中在1.5-2.5cm,肠管坏死长度与腹水量呈线性相关,坏死肠管越长,腹水量越多;肠管术中根据情况行肠管复位术,肠切除肠吻合术或肠外置术,早期手术能够减少毒素吸收,改善术后患儿一般情况,缩短住院时间。
[Abstract]:Objective: to analyze the clinical characteristics of congenital mesenteric hiatal hernia in children. The clinical data of 38 cases of mesenteric hiatal hernia proved by operation were analyzed and discussed. Results: 35 cases of vomiting, 30 cases of abdominal pain and 20 cases of abdominal distension were found at admission. There were 19 cases of fever, 14 cases of stopping exhaust and defecation, 2 cases of blood stool, 9 cases of preshock or shock, 8 cases of peritonitis. The preoperative diagnosis of mesenteric hiatal hernia in 5 cases, strangulated intestinal obstruction or internal hernia in 10 cases, mechanical intestinal obstruction in 15 cases, and unclear diagnosis in 6 cases. Other diagnosis: 2 cases; There were 2 cases of multiple hiatus. Among the above cases, 31 cases were caused by intestinal ischemia and necrosis, among which 26 cases were treated with intestinal resection and enterostomy and 5 cases were treated with intestinal excision and anastomosis. Conclusion: the early diagnosis of congenital mesenteric hiatal hernia is difficult, and it is easy to be misdiagnosed. Missed diagnosis, leading to intestinal ischemia necrosis, severe will lose a large number of intestinal tube, or even cause short bowel syndrome. For suspected cases, early surgical exploration, according to X-ray diagnosis of intestinal obstruction. There were "fixed no peristaltic loops" and "pseudotumor" signs. B-mode ultrasound could be used to detect the blood flow of the intestine and mesentery, the thickening of the intestinal wall edema, and the puncture of abdominal cavity if necessary, which provided the theoretical basis for the early operation intervention. There was no significant correlation between mesenteric necrosis and mesenteric location and incarceration time. The diameter of mesenteric fissure was about 1.5-2.5 cm, and the length of intestinal necrosis was linearly correlated with the quantity of ascites. The longer the necrotic bowel, the more ascites. According to the situation, intestinal tube reduction, intestinal resection and enterostomy or enterostomy, early operation can reduce the absorption of toxin, improve the general situation of children after operation, and shorten the hospitalization time.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R726.5

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