Emanuel B, Zlotnik P, Raffensperger J G
Surg Gynecol Obstet. 1978 Jun;146(6):926-8.
Eighty-eight patients with perforations of the gastrointestinal tract in infancy and childhood, excluding those caused by appendicitis, are presented. Fifty-five patients were four weeks of age or younger. Fourteen of the perforations occurred during the first year of life and 19 occurred between one and 15 years of age. The locations of perforations by order of frequency were the ileum, rectosigmoid, stomach and duodenum. The causes in order of frequency were necrotizing enterocolitis, ulcers, unknown causes, Hirschsprung's disease, atresia of the small intestine, volvulus, trauma, gastroschisis and ventriculoperitoneal shunts for hydrocephalus. A high index of suspicion, aided by roentgenograms, is essential for an early diagnosis. The over-all mortality was 49 of 88 patients. No reduction in mortality was observed in the last ten years, despite improved surgical techniques and better antimicrobial agents. Early recognition and rapid transport of the child to a pediatric intensive care unit with better supportive measures plus antimicrobial agents effective against both anaerobic and aerobis bacteria should reduce this high mortality.
本文介绍了88例婴儿期和儿童期胃肠道穿孔患者，但不包括阑尾炎引起的穿孔。55例患者年龄在4周及以下。其中14例穿孔发生在生命的第一年，19例发生在1至15岁之间。穿孔部位按频率依次为回肠、直肠乙状结肠、胃和十二指肠。病因按频率依次为坏死性小肠结肠炎、溃疡、不明原因、先天性巨结肠、小肠闭锁、肠扭转、创伤、腹裂和脑积水脑室腹腔分流术。借助X线检查，高度的怀疑指数对于早期诊断至关重要。88例患者中总体死亡率为49例。尽管手术技术有所改进且抗菌药物更好，但在过去十年中死亡率并未降低。早期识别并将患儿迅速转运至配备更好支持措施以及对需氧菌和厌氧菌均有效的抗菌药物的儿科重症监护病房，应可降低这种高死亡率。
