小儿急腹症中的妇科问题

Gynaecologic problems and acute abdomen in children

目的 分析小儿妇科疾病引起的急腹症的特征及临床误诊原因 ,并提出避免误诊的方法。方法 回顾我院外科 1990～ 2 0 0 1年以急腹症为主要表现的女性小儿生殖系统病例 2 0例。年龄2～ 14岁 ,平均 10 .2岁。其中 :卵巢囊肿 4例 ,卵巢畸胎瘤 7例 ,卵巢恶性卵黄囊肿 1例 ,黄体破裂 3例 ,处女膜闭锁 2例 ,盆腔炎 2例 ,原发性痛经 1例。结果 术前误诊 4例 ,黄体破裂误诊为阑尾炎 2例 ,卵巢囊肿误诊为阑尾炎 1例 ,处女膜闭锁误诊为盆腔包块 1例。手术治疗 16例 ,抗炎止血等保守治疗 3例 ,解痉止痛 1例。全部病例均痊愈出院。结论 小儿妇科急腹症分为破裂性疾病 ,肿瘤和炎症 ,幼童期 1～ 9岁以肿瘤性疾病为主。青春期 9岁以后即要考虑特有疾病如处女膜闭锁以及黄体破裂等 ,术前要了解妇科情况。诊断急性阑尾炎有疑问但又确有手术指征时 ,可以采取腹直肌纵切口。除非证实肿瘤为恶性 ,否则应尽量保留卵巢。

Objective To analyse the characteristics and misdiagnosis of acute abdomen caused by paediatric gynaecologic disease. Methods Twenty patients with paediatric gynaecologic disease presented as acute abdomen between 1990 and 2001 were retrospectively reviewed. The age ranged from 2 to 14 years with an average of 10.2 years. There were ovarian cyst in 4, ovarian teratoma in 7, malignant ovarian cyst in 1, corpus luteum rupture in 3, imperforate hymen in 2, pelvic inflammation in 2 and primary dysmenorrhea 1. Results One case of ovarian cyst was misdiagnosed as appendicitis and one case of imperforate hymen was misdiagnosed as pelvic mass. Sixteen patients underwent operative treatment (including 2 cases of laparoscopic assisted operations), 4 were received conservative therapy. All patients recovered satisfactory. Conclusions The gynaecology diseases in children are divided into rupture disease, tumour and inflammation. In evaluating acute abdomen in girls older than 9 years, menstrual history should be ascertained. With suspected but uncertain diagnosis of appendicitis, a vertical abdominal incision is recommended. Ovary should be preserved unless malignancy is confirmed.