儿童十二指肠溃疡穿孔的诊治体会。

Experience in diagnosis and treatment of duodenal ulcer perforation in children.

机构信息

Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China.

Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China.

出版信息

BMC Pediatr. 2023 Mar 30;23(1):144. doi: 10.1186/s12887-023-03957-8.

DOI:10.1186/s12887-023-03957-8

PMID:36997985

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10061964/

Abstract

BACKGROUND

This study aims to summarize our experience in diagnosis and treatment of pediatric duodenal ulcer perforation in a National Center for Children's Health.

METHODS

Fifty-two children with duodenal perforation hospitalized in Beijing Children's Hospital Affiliated to Capital Medical University from January 2007 to December 2021 were retrospectively collected. According to the inclusion and exclusion criteria, patients with duodenal ulcer perforation were included in the group. They were divided into the surgery group and the conservative group according to whether they received surgery.

RESULTS

A total of 45 cases (35 males and 10 females) were included, with a median age of 13.0 (0.3-15.4) years. Forty cases (40/45, 88.9%) were over 6 years old, and 31 (31/45, 68.9%) were over 12 years old. Among the 45 cases, 32 cases (32/45, 71.1%) were examined for Helicobacter pylori (HP), and 25 (25/32, 78.1%) were positive. There were 13 cases in the surgery group and 32 cases in the conservative group, without a significant difference in age between the two groups (P = 0.625). All cases in the surgery group and the conservative group started with abdominal pain. The proportion of history time within 24 h in the two groups was 6/13 and 12/32 (P = 0.739), and the proportion of fever was 11/13 and 21/32 (P = 0.362). The proportion of pneumoperitoneum in the surgery group was higher than that in the conservative group (12/13 vs. 15/32, P = 0.013). The fasting days in the surgery group were shorter than those in the conservative group (7.7 ± 2.92 vs. 10.3 ± 2.78 days, P = 0.014). There was no significant difference in the total hospital stay (13.6 ± 5.60 vs14.8 ± 4.60 days, P = 0.531). The operation methods used in the surgery group were all simple sutures through laparotomy (9 cases) or laparoscopy (4 cases). All patients recovered smoothly after surgery.

CONCLUSION

Duodenal ulcer perforation in children is more common in adolescents, and HP infection is the main cause. Conservative treatment is safe and feasible, but the fasting time is longer than the surgery group. A simple suture is the main management for the surgery group.

摘要

背景

本研究旨在总结我们在国家儿童医学中心诊治小儿十二指肠溃疡穿孔的经验。

方法

回顾性收集 2007 年 1 月至 2021 年 12 月首都医科大学附属北京儿童医院收治的 52 例十二指肠穿孔患儿的临床资料。根据纳入排除标准，将十二指肠溃疡穿孔患儿纳入研究，根据是否手术将患儿分为手术组和保守组。

结果

共纳入 45 例患儿（男 35 例，女 10 例），中位年龄 13.0（0.3-15.4）岁。40 例（40/45，88.9%）患儿年龄>6 岁，31 例（31/45，68.9%）患儿年龄>12 岁。45 例患儿中，32 例行幽门螺杆菌（HP）检查，25 例（25/32，78.1%）阳性。手术组 13 例，保守组 32 例，两组患儿年龄差异无统计学意义（P=0.625）。两组患儿均以腹痛起病，腹痛时间<24 h 比例分别为 6/13 和 12/32（P=0.739），发热比例分别为 11/13 和 21/32（P=0.362）。手术组气腹发生率高于保守组（12/13 比 15/32，P=0.013）。手术组患儿的禁食时间短于保守组（7.7±2.92 比 10.3±2.78 d，P=0.014）。两组患儿的总住院时间差异无统计学意义（13.6±5.60 比 14.8±4.60 d，P=0.531）。手术组的手术方式均为剖腹简单缝合（9 例）或腹腔镜简单缝合（4 例），术后患儿均顺利恢复。