新生儿胃穿孔18例诊治报告

Diagnosis and treatment of neonatal gastric perforation (a report of 18 cases)

目的 :探讨新生儿胃穿孔的诊断、治疗效果及预后因素。方法 :对 1 8例新生儿胃穿孔病例诊断、治疗及预后因素进行分析。结果 :1 8例患儿均有拒奶、腹胀、呕吐、呼吸困难等症状。腹部立位 X线片示膈下有大量游离气体。其中单纯穿孔 6例 ,多发穿孔 4例 ,胃壁缺损 7例 ,全胃壁缺如 1例。单纯及多发胃穿孔行胃修补术 ,3例同时行胃造痿术。胃壁肌层缺损行病变组织切除、胃壁修补及胃造痿术。 1例全胃壁肌层缺如仅行腹腔引流术。本组存活 8例 ;死亡 1 0例 ,病死率 5 5 .5 6%。死亡原因为多脏器功能衰竭、DIC。结论 :新生儿胃穿孔预后差 ,且受发病时间、就诊时间。

Objective:To discuss diagnosis, therapeutic efficacy and prognosis factors of neonatal gastric perforation. Methods:The diagnosis, therapeutic efficacy and prognosis factors for 18 cases of neonatal gastric perforation were analyses. Results:There were such symptoms, as swelling of abdomen, vomiting, dyspnea,etc. in 18cases.Abdominal erect film showed that amass of free gas was under the diaphragm. 6 cases were single perforation and 4 cases were multiple perforation. 7 cases were local defects of stomach wall and 1 case was complete defect of stomach wall. All perforations were on greater curvature of stomach. Prosthesis on stomach was carried out for the cases of single and multiple perforations among which 3 cases were treated with gastrostomosis at the same time. Cases of local defects of stomach wall were treated by resection of lesion and prosthesis of stomach wall. Drainage of abdominal cavity was carried out for 1 case of complete defect of stomach wall. 8 cases survived in the group and 10 cases died, the mortality being 55.56%. main causes of death were mutiple organ system failure and disseminated intravascular coagulation. Conclusion:Prognosis of neonatal gastric perforation is bad and affected by compositive factors such as the time of onset of illness and time for seeking medical advice and degree of severity, ect.