3765例儿童胃镜检查回顾性分析

Retrospective analysis of gastroscope findings in 3765 children

目的探讨具有上消化道症状的不同年龄组患儿胃镜检查的特征及胃镜检查的诊断价值。方法回顾性分析2008年1月至2017年12月首都儿科研究所附属儿童医院消化内科3 765例具有上消化道症状的患儿的胃镜资料,按年龄分为6组,新生儿期(≤28 d),婴儿期(29 d至1岁),幼儿期(>1~3岁),学龄前期(>3~6岁),学龄期(>6~11岁)及青春期(>11~18岁),比较不同年龄组患儿的胃镜特征。结果男2 132例,女1 633例,男女比为1.3∶1,发病年龄9 d至18岁。新生儿期5例,婴儿期81例,幼儿期244例,学龄前期925例,学龄期1 600例及青春期910例。慢性胃炎是常见病因,消化道畸形和消化道异物多见于婴幼儿期。总体幽门螺杆菌感染阳性率为13.4%,其中婴儿均为阴性,幼儿阳性率为4.4%,学龄前期为8.6%,学龄期为15.7%,青春期为16.3%。幽门螺杆菌感染者中消化性溃疡占14.0%,高于幽门螺杆菌阴性者的消化性溃疡比例[5.7%(164/2 902)],差异有统计学意义(P <0.05)。从2014年8月开展无痛胃镜,2015-2017年的无痛胃镜比例为79.9%。结论具有上消化道症状的不同年龄组患儿的常见病因不同;幽门螺杆菌感染的阳性率随年龄增大而增加;无痛胃镜技术的应用可减轻患儿的疼痛及不适感,提高了检查的质量及内镜下治疗的安全性和成功率。胃镜检查是明确具有上消化道症状各年龄组儿童病因的最主要方法,有重要的临床诊断价值。

Objective To study gastroscopic findings of children with upper gastrointestinal symptoms and assess the clinical application value of gastroscopy in the diagnosis of the children among different age groups. Methods The data of gastroscopic examination in the children with upper gastrointestinal symptoms among different age groups were retrospectively analyzed from January 2008 to December 2017. The patients were divided into six age groups, including neonatal period(<28 days), early infancy(29 days to one year), early childhood(>one year to three years), preschool age(>three to six years),school age(>six to 11 years), adolescence(>11-18 years). The differences in the children with upper gastrointestinal symptoms among different age groups in terms of gastroscopic characteristics were compared. Results A total of 3 765 patients had accepted gastroscopy, five cases of neonatal period, 81 cases of early infancy, 244 cases of early childhood, 925 cases of preschool age, 1 600 cases of school age, 910 cases of adolescence. Chronic gastritis was the common diease in the children with upper gastrointestinal symptoms. The digestive tract malformation and foreign bodies were mostly found in infancy. The proportion of Helicobacter pylori(H.pylori) infection in children was 13.4%, the positive rate of H.pylori was 0.0% in infancy, 4.4% in early childhood, 8.6% in preschool age, 15.7% in school age, 16.3% in adolescence. The proportion of peptic ulcer in the children who infected H.pylori was significantly higher than that in the uninfected. Painless gastroscopy was carried out in August 2014, 1 476 cases(79.9%) were safely completed the painless gastroscopy examination from 2015 to 2017.Conclusions The etiology of the children with upper gastrointestinal symptoms was different in different age groups. The positive rate of H.pylori infection increased with age. The application of painless gastroscopy can reduce the pain and discomfort of the children, increase the quality of examination, improve the safety and success rate of endoscopic treatment. Gastroscopy is the most important method to identify the etiology of children with upper gastrointestinal symptoms among different age groups.