儿童原发性小肠肿瘤的诊断(附29例分析)

Diagnosis of primary small intestinal tumors in children

目的:通过对儿童原发性小肠肿瘤早期临床表现的认识,以期获得更早期的诊断。方法:对1986～2002年收治的29例儿童原发性小肠肿瘤临床表现、继发疾病、诊断及误诊原因作回顾性分析。结果:29例小肠肿瘤中,良性16例,恶性13例。术前主要临床表现为反复发作腹痛22例,其中固定性腹痛8例,血便4例,腹块2例;继发肠套叠16例,其中2岁以上14例,肠梗阻4例,肠系膜淋巴结进行性增大1例。术前明确诊断者5例,24例误诊。结论:对儿童出现慢性腹痛尤其表现为固定于一个区域的腹痛、不明原因的血便、进行性肠系膜淋巴结肿大、反复发作的肠套叠及不全性肠梗阻应警惕小肠肿瘤的存在。

Objective To analyse the clinical manifestations of primary small-bowel tumors,attempting to learn making earlier diagnosis. Methods Twenty-nine cases of primary small-bowel tumors between 1986～2002 were retrospectively reviewed. Investigating their clinical manifestations, secondary affections, diagnosis and causes of misdiagnosis. Results Sixteen of the 29 cases were benign, while the other 13 were malignant. Repeated attacks of abdominal pain constituted the main clinical manifestation in 22 cases, in 8 cases the pain was fixed in one area. Other manifestation were bloody stool in 4 cases, abdominal mass in 2 cases, secondary intussusception in 16 cases (14 patients were >2 years old), intestinal obstruction in 4 cases, and progressive enlargement of mesenteric lymph nodes in 1 case. Five cases were diagnosed correctly, while the other 24 were misdiagnosed before operation. Conclusions Small-bowel tumors should be suspected when the following clinical manifestations appear in the children: chronic abdominal pain, especially when fixed in one area; bloody stool of unknown reason; progressive enlargement of mesenteric lymph nodes; repeated intussusception and incomplete ileus.