过量口服布洛芬致儿童十二指肠穿孔的诊治

Diagnosis and treatment of duodenal perforation caused by oral excessive ibuprofen in children

目的总结3例十二指肠穿孔的病因及诊治经验。方法通过回顾2016年9月14日至2017年6月20日我院收治的3例儿童十二指肠穿孔的病例资料，总结儿童十二指肠穿孔的原因、临床特点及治疗方法。结果3例患儿中，男2例，女1例；年龄为2岁、3岁、5岁；3例起病前均有上呼吸道感染发热病史，并多次口服布洛芬后出现急性腹痛，经查腹平片提示气腹。3例穿孔部位均为十二指肠球部前壁，直径0．5-1cm，其中2例少量气腹者行3D腹腔镜探查十二指肠穿孔修补术，1例因大量液气腹、休克严重行剖腹探查十二指肠穿孔修补术。3例修补后均以大网膜覆盖。3例均预后良好，无吻合口瘘、溃疡、粘连性肠梗阻等并发症。3例经消化内科随访检查均无幽门螺杆菌感染。结论短期内反复多次口服布洛芬可致儿童十二指肠穿孔。一旦确认消化道穿孔应紧急手术探查，腹腔镜修补十二指肠穿孔安全有效且恢复较快，若条件不允许可行剖腹探查穿孔修补术。

Objective To summarize the etiology, diagnosis and treatment of three cases of duodenal perforation. Methods The data of 3 cases of children with duodenal perforation in our hospital from September 14,2016 to June 20,2017 were retrospectively analyzed. The causes, clinical features and treatment of children＇s duodenal perforation were summarized. Results A total of 2 males and 1 females aged 2 years,3 years and 5 years were included in the 3 cases. All 3 cases had fever history of upper respiratory tract infection before onset. Acute abdominal pain occurred after oral administration of ibuprofen several times, and all the abdominal plain films prompted pneumoperitoneum. Three cases of perforation sites were duodenal anterior wall, diameter were 0. 5-1 cm. Two cases of small amount of pneumoperitoneum were explored and repaired the duodenal perforation by 3D laparoscopic, 1 case underwent laparotomy to repair the duodenal perforation due to a large number of liquid pneumoperitoneum and severe shock. Repair of 3 cases were covered with omentum. Three cases were all cured without anastomotic fistula, ulcer, adhesive intestinal obstruction or other complications. Followed-up in the department of gastroenterology ,3 cases had no Helico- bacter pylori infection. Conclusion Repeatedly oral administration of ibuprofen can cause duodenal perforation in children in the short term. Once the digestive tract perforation confirmed, emergency surgical exploration is needed. Laparoscopic repair of duodenum perforation is safe and effective and may have a faster recovery. We can choose exploratory laparotomy if conditions are not allowed.