川崎病并发急腹症16例临床分析

Clinical analysis of 16 cases of Kawasaki disease complicated with acute abdomen

目的探讨川崎病(KD)并发急腹症患儿的临床特征、诊断、治疗及预后。方法回顾性分析2015年8月1日至2019年7月31日广州医科大学附属广州市妇女儿童医疗中心收治的16例KD并发急腹症患儿的临床表现、实验室检查、腹部B超、腹部平片和腹部CT检查结果、冠状动脉病变情况及转归。年龄、白细胞、血红蛋白、血小板及生化指标等计量资料采用M(范围)表示。结果16例KD并发急腹症患儿中男7例,女9例;就诊年龄为4岁8个月(7月龄~8岁)。KD并发胆囊炎9例,肠梗阻5例,急性阑尾炎2例,坏死性小肠结肠炎2例,急性腹膜炎2例,急性胰腺炎1例(其中3例患儿合并2种及2种以上急腹症疾病)。16例均有腹痛症状,7例有呕吐,4例明显腹胀,1例有血便。16例患儿均行腹部B超检查:8例表现为胆囊增大及胆囊壁水肿、增厚,2例见阑尾炎声像,2例见肠梗阻,1例见胰腺肿大;8例行腹部平片检查:2例坏死性小肠结肠炎改变,2例肠梗阻表现;3例行腹部CT检查:1例胆囊壁水肿,1例腹膜炎表现,2例肠梗阻,1例胰腺肿大。16例患儿均予大剂量静脉注射用免疫球蛋白(IVIG)(2 g/kg)及抗血小板药物治疗,但有8例IVIG无反应,均再次予IVIG 2 g/kg治疗,其中4例患儿仍发热,予甲泼尼龙(MP)静脉治疗后热退。有2例分别行小肠造瘘术及腹腔穿刺引流术。16例患儿均随访至出院后6个月,在疾病急性期或随访期间共有4例(25%)合并冠状动脉瘤(CAA)。结论KD并发急腹症以胆囊炎、肠梗阻较多见,除KD典型症状外主要表现为腹痛及呕吐,腹部B超、平片和CT有助于早期诊断。此外,KD并发急腹症患儿IVIG无反应及CAA发生率相对较高。

Objective To investigate the clinical manifestations,diagnosis,treatment and prognosis of Kawasaki disease(KD)complicated with acute abdomen in children.Methods Clinical manifestations,laboratory examinations,abdominal B-ultrasound scans,abdominal plain films,abdominal CT findings,coronary artery lesions and prognosis of 16 children with KD and acute abdomen admitted to Guangzhou Women and Children′s Medical Center,Guangzhou Medical University from August 1,2015 to July 31,2019 were retrospectively analyzed.The measurement data of age,leukocyte,hemoglobin,platelet and biochemical indexes are expressed by M(range).Results A total of 16 cases were included,involving 7 males and 9 females aged 4 years and 8 months(7 months to 8 years).Among them,9 cases of KD complicated with cholecystitis,5 cases with intestinal obstruction,2 cases with acute appendicitis,2 cases with necrotizing enterocolitis,2 cases with acute peritonitis and 1 case with acute pancreatitis.There were 3 cases complica-ted with 2 or more kinds of acute abdomen diseases.All 16 patients had symptoms of abdominal pain,7 cases had vomiting,4 cases had obvious abdominal distension and 1 case had bloody stool.Abdominal B-ultrasound was performed in all cases,and 8 cases showed enlargement of gallbladder and edema and thickening of gallbladder wall,2 cases of appendicitis,2 cases of intestinal obstruction and 1 case of pancreatic enlargement.Abdominal plain film examination was performed in 8 cases,suggesting necrotizing enterocolitis in 2 cases and intestinal obstruction in 2 cases.Abdominal CT examination was performed in 3 cases,including edema of gallbladder wall in 1 case,peritonitis in 1 case,intestinal obstruction in 2 cases and enlargement of pancreas in 1 case.All the 16 cases were treated with pulsed intravenous immunoglobulin(IVIG)at 2 g/kg and antiplatelet agents.Eight IVIG-resistant cases were treated with the second dose of IVIG at 2 g/kg,among whom,4 children still had fever and intravenous Methylprednisone was given.Two cases underwent enterostomy and abdominal puncture drainage.All the 16 children were followed up until 6 months after discharge,and 4 cases(25%)were complicated with coronary artery aneurysm(CAA)during the acute stage or follow-up period.Conclusions KD complicated with acute abdomen is more commonly manifested as cholecystitis and intestinal obstruction.Besides the classic symptoms of KD,abdominal pain and vomiting are the most common in KD with acute abdomen.Abdominal ultrasound,plain film and CT examinations are conductive to the early diagnosis of KD complicated with acute abdomen.In addition,the incidence of IVIG-resistance and CAA is relatively high in children with KD complicated with acute abdomen.