以贫血为首发症状的食管裂孔疝9例分析

Clinical characteristics of 9 patienets of hiatal hernias with the first symptom of anemia

【目的】探讨以贫血为首发症状的食管裂孔疝患儿的临床特点及诊治要点。【方法】对9例贫血为首发症状的食管裂孔疝患儿的临床资料进行分析。全部患儿进行了血常规、血清铁、铁蛋白、总铁结合力检测,行胸片、上消化道造影检查。【结果】9例均符合缺铁性贫血诊断标准。就诊时血红蛋白值为(52±12)g/L,铁蛋白值为(3.0±1.8)ng/mL,血清铁值为(2.7±1.8)μmol/L,总铁结合力值为(87.21±5.78)μmol/L。所有患儿均无"呕吐、呕血、黑便"等消化道症状。胸片检查疑诊、消化道造影证实食管裂孔疝。8例给予手术治疗,1例家属拒绝手术出院。【结论】缺铁性贫血为婴幼儿常见病,诊断时需重视缺铁性贫血的病因诊断,尤其是一些先天性胃肠道畸形,如食管裂孔疝;对此类患儿可行胸片筛查,手术是治疗成功的关键。

[Objective] To explore the clinical characteristics and the main points of treatment for the hiatal hernias patients with the first symptom of anemia. [Methods] Analysis of the clinical data of 9 cases of hiatal hernias patients whose first symptom was anemia. All the patients had been given the tests of routine blood, serum iron, serum ferrtin, total i- ron binding capactiy, besides these,they also had done the X ray of chest and upper gastrointestinal radiography. [Results] All the 9 cases met the of criterion of iron deficiency anemia. The mean level of the hemoglobin,serum ferritin,serum i- ron,total iron binding capacity was （52 ± 12）g/L, （3.0±1.8）ng/mL, （2.7± 1.8）μmol/L, （87.21±5.78）Fmol/L individi- al. All of them did not have the gastrointestinal symptoms such as＂abdominal pain, vomitingand melena＂. The X ray of the chest showed abnormal,the diagnosis of hiatal hernias was proved by upper gastrointestinal radiography. 8 cases had been given surgery, l case family refused operation and gave up threatment. [Conclusion] Iron-deficiency anaemia is common for infants, it can be diagnosed easily by the tests of iron metabolism. It is important to find out the cause of iron deficiency, especially congenital malformation gastrointestinal tract such as hiatal hernias. The X-ray of chest should routinely been done to the patient of anemian to avoid misdiagnosis. Surgery is the key factor for the successful treatment.