Grund K E, Dzieniszewski G P
Z Kinderchir. 1981 Jan;32(1):56-68. doi: 10.1055/s-2008-1063234.
Between 1958 and 1979, 48 neonates with gastrointestinal perforation were treated in the University Clinic, Mainz. The high rate of premature births (c. 40%) was noteworthy, as were the frequent complications in the perinatal period. An accurate diagnosis was made more difficult by the peculiarities of this age, and the multipilicity of possible causes of perforation. The first clinical symptoms were non-specific. In only 36% of the patients was the so-called "pathognomonic" pneumoperitoneum diagnosed on X-ray. The most common site of perforation was the ileo-coecal region, the commonest causes of perforation were intestinal obstruction (atresias, Hirschsprung's disease) and necrotising enterocolitis. In almost 1/3 of all children, the exact causes of perforation could not be determined from the history, intra-operative findings, or histology. The operative procedure depends on the individual case. It must be suited to the site and cause of the perforation, and to the subsequent disturbances. Of the post-operative complications, those related to paediatric intensive-care proved to be more serious than the directly surgical complications. The total mortality was, at 63%, high. The main cause of death was found to be septicemia, and septic complications. An improvement in the results can only be attained through early diagnosis, immediate operation and peri-operative intensive care.
1958年至1979年间，美因茨大学诊所共治疗了48例患有胃肠道穿孔的新生儿。早产率较高（约40%），围产期并发症频繁，这些都值得关注。由于这个年龄段的特殊性以及穿孔可能原因的多样性，准确诊断变得更加困难。最初的临床症状不具特异性。仅36%的患者在X射线下被诊断出有所谓的“典型性”气腹。穿孔最常见的部位是回盲部，穿孔最常见的原因是肠梗阻（闭锁、先天性巨结肠）和坏死性小肠结肠炎。在几乎所有儿童中，近1/3无法从病史、术中发现或组织学确定穿孔的确切原因。手术程序取决于具体病例。它必须适合穿孔的部位和原因以及随后的紊乱情况。在术后并发症中，与儿科重症监护相关的并发症被证明比直接的手术并发症更严重。总死亡率高达63%。死亡的主要原因是败血症和感染性并发症。只有通过早期诊断、立即手术和围手术期重症监护才能改善治疗结果。
