小儿肠系膜裂孔疝临床病例特点分析.doc

小儿肠系膜裂孔疝临床病例特点分析 摘要：目的：结合临床病例，对小儿先天性肠系膜裂孔疝的临床病例特点进行分析。 方法：回顾性分析我院外科2007年2月一2014年2月间住院治疗，并经手术证实为肠系 膜裂孔疝者29例，对上述病例的临床资料进行分析探讨。结果：入院时患儿的临床表现： 呕吐26例，腹痛22例，腹胀11例，停止排气排便7例，血便2例；伴休克前期或休克者 4例，伴腹膜炎者3例；行腹腔穿刺为血性腹水者9例。术前即高度怀疑肠系膜裂孔疝或腹 内疝10例；术前诊断机械性肠梗阻11例；术前不明确诊断4例；术前误诊为其他疾病者4 例；其中多发裂孔疝有2例。上述病例中致肠缺血坏死23例，其小19例行肠切除肠吻合术， 4例行肠外置术。结论：先天性肠系膜裂孔疝早期诊断困难，极易误诊、漏诊，导致肠缺血 坏死，严重者将丢失大量肠管，甚至造成短肠综合征。对于疑似病例，应早期手术探查术中 根据肠管缺血情况行肠管复位术，肠切除肠吻合术或肠外置术。 关键词：肠系膜裂孔疝；先天性；发病机理；病例特点 Abstract: Aim： By studying clinical cases, the clinical characteristics of congenital mesenteric hiatal hernia in children including pathogenesis, diagnosis and treatment were analyzed. Methods： A retrospective analysis was conducted? The clinical data of 29 hospitalized patients with con genital mesenteric hiatal hernia in our hospital from 2007 February to 2014 Februaiy were studied. Results: In all patients, the major clinical symptoms include vomiting in 26 cases, abdominal pain in 22 cases, abdominal distention in 11 cases, the absence of exhaust and defecate in 7 cases, bloody stool in 2 cases. Moreover, 4 cases complicated with hypovolemic shock, 3 cases with peritonitis, 9 cases with bloody ascites by abdominal puncture? Among these 29 patients, 10 cases were highly suspected mesenteric hiatal hernia preoperatively, 11 cases were diagnosed as intestinal mechanical obstruction at emergency. No definitive diagnoses were given in 4 cases, whereas other 4 cases were misdiagnosed preoperatively. Multiple Mesenteric hiatal happened in 2 cases. 23 cases were demonstrated intestinal ischemic necrosis during operation, in which 19 cases implemented intestinal resection and anastomosis and 4 cases did intestinal exteriorization. Conclusion： Early diagnosis of congenital mesenteric hiatal hernia is difficult. Delayed diagnosis might lead to intestinal ischemia and necrosis, even resulting in short bowel syndrome. For suspected patients, early exploratory operation should be preformed to avoid massintestine lose. Intestinal reposition,