本文關(guān)鍵詞：小兒腸系膜裂孔疝病例特點(diǎn)的臨床研究　出處：《首都醫(yī)科大學(xué)》2016年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 腸系膜裂孔疝 先天性 發(fā)病機(jī)理 病例特點(diǎn)

【摘要】：目的:結(jié)合臨床病例,對(duì)小兒先天性腸系膜裂孔疝的臨床病例特點(diǎn)進(jìn)行分析。方法:回顧性分析我院外科2007年2月—2016年2月間住院治療,并經(jīng)手術(shù)證實(shí)為腸系膜裂孔疝者38例,對(duì)上述病例的臨床資料進(jìn)行分析探討。結(jié)果:入院時(shí)患兒的臨床表現(xiàn):嘔吐35例,腹痛30例,腹脹20例,發(fā)熱19例,停止排氣排便14例,血便2例,伴休克前期或休克者9例,伴腹膜炎者8例,其中15例行腹腔穿刺均為血性腹水或者不凝血。術(shù)前診斷腸系膜裂孔疝5例,絞窄性腸梗阻或腹內(nèi)疝10例,機(jī)械性腸梗阻15例,不明確診斷6例,其他診斷2例;多發(fā)裂孔有2例。上述病例中致腸缺血壞死31例,其中26例行腸切除腸吻合術(shù),5例行腸外置術(shù)。結(jié)論:先天性腸系膜裂孔疝早期診斷困難,極易誤診、漏診,導(dǎo)致腸缺血壞死,嚴(yán)重者將丟失大量腸管,甚至造成短腸綜合征。對(duì)于疑似病例,應(yīng)早期手術(shù)探查,根據(jù)X線(xiàn)診斷腸梗阻,可有“固定無(wú)蠕動(dòng)腸襻”以及“假腫瘤”征,B超可探查腸管血運(yùn)情況及腸系膜、腸壁水腫增厚改變,必要時(shí)腹腔穿刺,為早期手術(shù)干預(yù)提供理論依據(jù);腸管壞死與腸系膜位置、嵌頓時(shí)間無(wú)明顯相關(guān)性,腸壞死對(duì)應(yīng)腸系膜裂孔直徑多集中在1.5-2.5cm,腸管壞死長(zhǎng)度與腹水量呈線(xiàn)性相關(guān),壞死腸管越長(zhǎng),腹水量越多;腸管術(shù)中根據(jù)情況行腸管復(fù)位術(shù),腸切除腸吻合術(shù)或腸外置術(shù),早期手術(shù)能夠減少毒素吸收,改善術(shù)后患兒一般情況,縮短住院時(shí)間。
[Abstract]:Objective: to analyze the clinical characteristics of congenital mesenteric hiatal hernia in children. The clinical data of 38 cases of mesenteric hiatal hernia proved by operation were analyzed and discussed. Results: 35 cases of vomiting, 30 cases of abdominal pain and 20 cases of abdominal distension were found at admission. There were 19 cases of fever, 14 cases of stopping exhaust and defecation, 2 cases of blood stool, 9 cases of preshock or shock, 8 cases of peritonitis. The preoperative diagnosis of mesenteric hiatal hernia in 5 cases, strangulated intestinal obstruction or internal hernia in 10 cases, mechanical intestinal obstruction in 15 cases, and unclear diagnosis in 6 cases. Other diagnosis: 2 cases; There were 2 cases of multiple hiatus. Among the above cases, 31 cases were caused by intestinal ischemia and necrosis, among which 26 cases were treated with intestinal resection and enterostomy and 5 cases were treated with intestinal excision and anastomosis. Conclusion: the early diagnosis of congenital mesenteric hiatal hernia is difficult, and it is easy to be misdiagnosed. Missed diagnosis, leading to intestinal ischemia necrosis, severe will lose a large number of intestinal tube, or even cause short bowel syndrome. For suspected cases, early surgical exploration, according to X-ray diagnosis of intestinal obstruction. There were "fixed no peristaltic loops" and "pseudotumor" signs. B-mode ultrasound could be used to detect the blood flow of the intestine and mesentery, the thickening of the intestinal wall edema, and the puncture of abdominal cavity if necessary, which provided the theoretical basis for the early operation intervention. There was no significant correlation between mesenteric necrosis and mesenteric location and incarceration time. The diameter of mesenteric fissure was about 1.5-2.5 cm, and the length of intestinal necrosis was linearly correlated with the quantity of ascites. The longer the necrotic bowel, the more ascites. According to the situation, intestinal tube reduction, intestinal resection and enterostomy or enterostomy, early operation can reduce the absorption of toxin, improve the general situation of children after operation, and shorten the hospitalization time.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R726.5

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