儿童消化道穿孔39例临床分析

Analysis of 39 Cases of Clinical Treatment of Children With Digestive Tract Perforation

目的探讨儿童消化道穿孔的病因、诊断、治疗,提高救治存活率。方法对2002年1月～2014年10月收治的39例儿童消化道穿孔病例进行临床分析,38例通过手术探查予以修补穿孔、坏死肠管切除吻合和肠管造瘘等不同手术方式的治疗。结果胃穿孔7例,十二指肠穿孔5例,小肠穿孔15例,结肠穿孔11例;手术治疗38例,1例明确诊断后未行手术放弃治疗,救治存活30例,死亡4例（胃穿孔1例,中肠扭转坏死穿孔2例,结肠穿孔1例）,4例术后因病情危重放弃治疗自动出院。结论儿童消化道穿孔病因复杂,起病急、进展快、病死率高。提高救治存活率的关键在于早期诊断、及时快捷的手术治疗、术后监护和支持治疗。

Objective To explore the etiology,diagnosis and treatment of children digestive tract perforation,improve survival rate. Methods On 2002 January- 2014 October treated 39 cases of children with gastrointestinal perforation were clinically analyzed,38 cases by surgical exploration to repair in the treatment of perforation,necrotic bowel resection and anastomosis and colostomy in different operation mode. Results gastric perforation 7 cases,duodenal perforation in 5cases,15 cases of small bowel perforation,11 cases of colon perforation; surgical treatment of 38 cases,1 case was diagnosed after operation had been done to give up treatment,treatment 30 cases survived,4 cases died（ 1 cases,gastric perforation in midgut olulus necrosis and perforation in 2 cases,perforation of colon in 1 cases）. 4 patients gave up treatment and discharged from hospital after critically ill children. Conclusion Digestive tract perforation complicated causes of acute onset,rapid progress,and high mortality rate. Improving the survival rate is the key to early diagnosis,timely and efficient operation therapy,postoperative care support treatment.