儿童上消化道溃疡173例临床分析

Upper gastrointestinal ulcer in children: a clinical analysis of 173 cases

目的 探讨儿童上消化道溃疡的临床表现和胃镜特点。方法 对2011年1月至2021年5月于中国医科大学附属盛京医院内镜中心完成胃镜检查并首次发现上消化道溃疡的0~14岁患儿进行回顾性研究。根据病因不同分为原发性溃疡组(简称原发组,n=148)和继发性溃疡组(简称继发组,n=25)。比较两组患儿的临床资料。结果 共纳入173例上消化道溃疡患儿,男女比例3.9∶1。与女孩相比,男孩的上消化道溃疡中十二指肠溃疡和原发性溃疡的占比较高(P<0.05)。与6岁以下儿童相比,6~14岁儿童十二指肠溃疡和原发性溃疡占比较高,巨大溃疡和多发溃疡少见。原发组148例患儿中,幽门螺杆菌的感染率为64.2%(95例);腹痛是最常见的临床症状,共101例(68.2%);十二指肠溃疡多见(115例,77.7%),其次为胃溃疡(25例,16.9%)及食管溃疡7例(4.7%);多发溃疡32例(21.6%);出现并发症的有70例(47.3%),其中最常见的为出血(63例,43.6%)。继发组25例患儿中,最常见的临床症状也是腹痛(9例,36%),但较原发组发生率低(P<0.05);引发继发性溃疡最常见的原因是消化道异物,共17例(68%),其次是腹型过敏性紫癜5例(20%)及克罗恩病3例(12%);出现多发溃疡及巨大溃疡的比例较原发组高(P<0.05)。结论 儿童上消化道溃疡男孩多发,且男孩多为十二指肠溃疡和原发性溃疡。年长儿的上消化道溃疡多为十二指肠溃疡和原发性溃疡,巨大溃疡和多发溃疡相对少见。原发性溃疡临床表现多样,以腹痛为主,十二指肠溃疡多见,并发症以出血为主;继发性溃疡的临床症状及内镜表现与其原发病因密切相关,并且更易诱发巨大溃疡和多发溃疡。

Objective To study the clinical manifestations and gastroscopic characteristics of upper gastrointestinal ulcer in children.Methods A retrospective analysis was performed for the children who underwent gastroscopy and were found to have upper gastrointestinal ulcer for the first time at the Endoscopy Center of Shengjing Hospital,China Medical University,from January 2011 to May 2021.According to the cause of the disease,they were divided into primary ulcer group(primary group;n=148) and secondary ulcer group(secondary group;n=25).The clinical data were compared between the two groups.Results A total of 173 children with upper gastrointestinal ulcer were enrolled,with a male/female ratio of 3.9:1.Compared with girls,boys had significantly higher proportions of duodenal ulcer and primary ulcer(P<0.05).Compared with the children aged below 6 years,the children aged 6-14 years had higher proportions of duodenal ulcer and primary ulcer and lower proportions of giant ulcer and multiple ulcers.Of the 148children in the primary group,95(64.2%) had Helicobacter pylori infection.Abdominal pain was the most common clinical symptom and was observed in 101 children(68.2%).Duodenal ulcer was common and was observed in 115children(77.7%),followed by gastric ulcer in 25 children(16.9%) and esophageal ulcer in 7 children(4.7%).Multiple ulcers were observed in 32 children(21.6%).Seventy children(47.3%) experienced complications,among which bleeding was the most common complication and was observed in 63 children(43.6%).Of the 25 children in the secondary group,abdominal pain was the most common clinical symptom and was observed in 9 children(36.0%),with a significantly lower incidence rate than the primary group(P<0.05);foreign body in the digestive tract was the most common cause of ulcer and was observed in 17 children(68%),followed by abdominal Henoch-Schonlein purpura in 5children(20.0%) and Crohn’s disease in 3 children(12.0%).The secondary group had a significantly higher proportion of multiple ulcer or giant ulcer than the primary group(P<0.05).Conclusions Upper gastrointestinal ulcer is more common in boys than girls,and duodenal ulcer and primary ulcer are more common in boys.Children aged 6-14 years often have duodenal ulcer and primary ulcer,and giant ulcer and multiple ulcers are relatively uncommon.Primary ulcer in children has a variety of clinical manifestations,mainly abdominal pain,and duodenal ulcer is relatively common,with bleeding as the main complication.The clinical symptoms and endoscopic manifestations of secondary ulcer are closely associated with the primary causes,and it is more likely to induce huge ulcers and multiple ulcers.