Stav K, Reif S
Pediatric Gastrointestinal Unit, Dana Children's Hospital, Souraski Medical Center, Tel Aviv.
Harefuah. 2000 Apr 2;138(7):534-8, 615.
During 1990-1997 we investigated 201 children with gastrointestinal bleeding. Average age was 3.9 +/- 6 years; 57.2% were males. There were 129 (64.2%) cases of lower and 72 (35.8%) of upper GI bleeding. Complications of upper GI bleeding were more severe than those of the lower: 6 of 8 (75%) patients who deteriorated into hypovolemic shock had upper GI bleeding; 40 of 50 (80%) who required i.v. fluids (crystaloids and/or blood) had also bled from the upper GI tract; but anemia was more frequent (27.7% vs 17%) in lower GI bleeding. The main etiology for upper GI bleeding was peptic ulcer, and for lower GI bleeding anal fissure. Mean hospital stay for upper GI bleeding was 3.87 +/- 2.61 days vs 3.40 +/- 3.51 for lower (not significant). In 34% the etiology of bleeding was undetermined. Although current literature refers to intussusception as a common cause of GI bleeding in infancy, we had no such cases. This difference might have resulted from our diagnoses being made earlier, before mucosal damage could have caused bleeding. We found polyps the second most frequent cause for lower GI bleeding in children. Endoscopy was of more benefit than any other diagnostic method, while barium enema and ultrasound had no diagnostic value. Stool culture did not contribute to diagnosis: only 3 of 36 were positive, so it is only necessary when there is bloody diarrhea.
1990年至1997年间，我们对201例胃肠道出血患儿进行了调查。平均年龄为3.9±6岁；57.2%为男性。下消化道出血129例（64.2%），上消化道出血72例（35.8%）。上消化道出血的并发症比下消化道出血更严重：8例病情恶化为低血容量休克的患者中有6例（75%）为上消化道出血；50例需要静脉输液（晶体液和/或血液）的患者中有40例（80%）也有上消化道出血；但下消化道出血时贫血更为常见（27.7%对17%）。上消化道出血的主要病因是消化性溃疡，下消化道出血的主要病因是肛裂。上消化道出血的平均住院时间为3.87±2.61天，下消化道出血为3.40±3.51天（无显著差异）。34%的出血病因未明确。虽然目前的文献将肠套叠视为婴儿胃肠道出血的常见原因，但我们没有此类病例。这种差异可能是由于我们在黏膜损伤导致出血之前就更早地做出了诊断。我们发现息肉是儿童下消化道出血的第二常见原因。内镜检查比任何其他诊断方法都更有帮助，而钡剂灌肠和超声检查没有诊断价值。粪便培养对诊断没有帮助：36例中只有3例呈阳性，所以只有在有血性腹泻时才需要进行。
