新生儿自发性胃穿孔临床病理特点和病因探讨

Clinicopathological characteristics and potential etiologies of neonatal spontaneous gastric perforation

目的 探讨新生儿自发性胃穿孔的病因和临床病理特点.方法 对本院自2001至2009年,治疗的15例胃穿孔新生儿进行回顾性分析,全部病例采用免疫组织化学方法进行研究.结果 本病典型的临床表现有呕吐、腹胀、呼吸窘迫等,腹部立位X线平片显示膈下游离气体及腹腔积液.穿孔部位大多在胃大弯,本组8例死亡,病死率53.33%,其中6例为出生后1 d内出现症状.镜下观察胃壁肌层变薄、缺损,ICC减少.结论 新生儿自发性胃穿孔与胃壁结构异常和ICC减少有关.预后与发病时间、手术时间等关系更为密切.

Objective To study the etiology and clinicopathological features of neonatal spontaneous gastric perforation. Methods The clinical data of 15 cases with neonatal gastric perforation seen from 2001 to 2009 were retrospectively analyzed. Immunohistochemical staining was adopted for all the cases. Results The typical clinical manifestations of this disease were vomiting, abdominal distention and respiratory distress. Abdominal orthostatic X-ray showed free gas under diaphragm and seroperitoneum. In most of the cases the stomach perforation occurred at the greater curvature. Eight of the cases died in this group, the mortality was 53.33%. Six of the deaths occurred within 1 day after birth with symptoms. There were thinning and defect of stomach wall muscle and interstitial cells of Cajal （ ICC ） reduction as demonstrated by microscope. Conclusions Spontaneous neonatal gastric perforation is assosilated with abnormal gastric wall structure and reduction of ICC. Prognosis is closely related to the time of onset and the timely surgical operation.