Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
Pediatr Neonatol. 2019 Dec;60(6):634-640. doi: 10.1016/j.pedneo.2019.03.006. Epub 2019 Mar 21.
To describe the characteristics, treatments, and prognosis of pediatric gastric perforation patients beyond neonatal period.
Twenty pediatric patients beyond neonatal period were included in this study. Medical records were reviewed and clinical characteristics were analyzed. According to the outcomes, patients were divided into the survival group and the death group. Death time was documented, and survival patients were followed up. The degree of severity was calculated using pediatric critical illness score (PCIS). Differences between the two groups were analyzed by the Student's t-test, Mann-Whitney test and Chi-square test appropriately.
Gastric perforation was diagnosed in 20 pediatric patients beyond neonatal period, including 6 males (30%) and 14 females (70%), with the age of 37.18 (15.90, 107.12) months, and the range was from 4.30 months to 14.17 years old. They had different manifestations, etiologies, sites of perforation and surgery procedures. Among the 20 cases, 14 (70%) survived and 6 (30%) died. Age, gender, length and number of perforation had no statistically difference between the two groups. However, PCIS, ischemia of gastrointestinal wall, and transmural necrosis of gastric wall were statistically different. For the survival group, during a follow-up period of 50 (36, 68) months, ranging from 2 months to 8 years and 7 months, one patient had a second-time perforation, another 3 patients had brain injury symptoms, and the rest 10 patients had good quality of lives.
Gastric perforation of pediatric patients beyond neonatal period causes a mortality of 30% on this study. Spontaneous great curvature of gastric wall perforation has the highest morbidity. Low PCIS predicts for unfavorable prognosis. Most of the survival patients have satisfactory living quality after operation.
描述新生儿期后小儿胃穿孔患者的特征、治疗方法和预后。
本研究纳入 20 例新生儿期后小儿胃穿孔患者。回顾病历资料，分析临床特征。根据结局将患者分为生存组和死亡组，记录死亡时间，对生存患者进行随访。采用小儿危重病评分（PCIS）计算疾病严重程度。采用 Student's t 检验、Mann-Whitney 检验和卡方检验对两组间差异进行分析。
新生儿期后胃穿孔诊断 20 例患儿，男 6 例（30%），女 14 例（70%）；年龄 37.18（15.90，107.12）个月，4.30 个月14.17 岁。临床表现、病因、穿孔部位及手术方式不同。20 例中 14 例（70%）存活，6 例（30%）死亡。两组间年龄、性别、穿孔长度和数量比较，差异无统计学意义；PCIS、胃肠道壁缺血、胃壁全层坏死比较，差异有统计学意义。生存组随访 50（36，68）个月，2 个月8 年 7 个月，1 例二次穿孔，3 例遗留脑损伤症状，其余 10 例生活质量良好。
本研究新生儿期后小儿胃穿孔死亡率为 30%。自发性胃大弯壁穿孔发病率最高。低 PCIS 预测预后不良。大多数生存患者术后生活质量良好。
