新生儿先天性胃壁肌层缺损穿孔13例临床分析

Clinical Analysis of 13 Neonates of Gastric Perforation Caused by Congenital Defects of Gastric Musculature

目的:探讨先天性胃壁肌层缺损致新生儿胃穿孔的临床症状及诊治措施。方法:回顾性分析2012年9月-2018年2月本院收治的13例先天性胃壁肌层缺致胃穿孔患儿临床资料,对胃穿孔的诊断及治疗转归情况总结分析。结果:临床表现有拒奶、哭闹、腹胀、呕吐及呼吸困难,腹部立位X线平片均显示膈下有大量游离气体,无明显胃泡显影。确诊后6 h内行剖腹探查、胃修补术,术后病理检查证实穿孔处胃壁肌层缺损。病变部位分别为胃底部3例(23.1%),胃大弯9例(69.2%),胃小弯1例(7.7%)。其中2例(15.4%)合并先天性肠旋转不良。术后呼吸机支持≤48 h有9例,>48 h有4例,平均(29.27±23.50)h。11例(84.6%)治愈出院,平均住院时间(20.36±2.54)d,其中1例(7.7%)术后出现切口疝,二次手术后痊愈。2例(15.4%)出现感染性休克、病情恶化,放弃治疗后死亡。结论:先天性胃壁肌层缺损主要由胃壁发育缺陷引起,胃内压增高是穿孔的诱因,及早确诊、尽早手术探查和积极的围手术期治疗是提高治愈率的关键。

Objective:To explore the pathogenesis and treatment of neonates gastric perforation caused by congenital defects of gastric musculature.Method:The clinical data of 13 neonates with gastric perforation caused by congenital defects of gastric musculature from September 2012 to February 2018 were analyzed retrospectively.The diagnosis and treatment outcome of gastric perforation were summarized and analyzed.Result:Clinical manifestations include rejection of milk,crying,abdominal distention,vomiting and dyspnea.Abdominal standing X-ray plain film showed a large amount of free gas under the septum,no obvious gastric bubble development.Probe laparotomy and gastric repair were performed within 6 h after diagnosis,and postoperative pathological examination confirmed the defects of gastric musculature at perforation.The lesion site was gastric fundus in 3 cases (23.1%),9 cases (69.2%) of greater gastric curvature,and 1 case (7.7%) of minor gastric curvature.2 cases (15.4%) of them were associated with congenital malrotation of the intestine.There were 9 cases of ventilator support ≤48 h after operation and 4 cases of > 48 h,with an average (29.27±23.50) h.Eleven cases (84.6%) was cured and discharged,with the average hospitalization time (20.36±2.54) d,of which 1 case (7.7%) was cured after the second operation of incisional hernia.Two cases (15.4%) died after septic shock,condition deteriorated and treatment abandoned.Conclusion:The congenital defect of gastric musculature is mainly caused by the development defect of gastric wall.The increase of gastric internal pressure is the cause of perforation.Early diagnosis,early surgical exploration and active perioperative treatment are the key to improve the cure rate.