摘要目的 探讨婴幼儿十二指肠穿孔的原因、诊断及手术方式.方法 回顾性分析2010年1月至2017年12月收治的8例婴幼儿十二指肠穿孔患儿的临床资料.其中,男6例,女2例;年龄为(20.3±9.3)个月,年龄范围9～34个月;发病时间为(3.5±1.2)d,时间范围2～6 d.术前有典型腹膜炎体征4例.腹部X线平片显示膈下游离气体2例,腹腔穿刺4例均抽出淡绿色肠液.结果 本组8例均为单发穿孔,其中十二指肠球部穿孔7例,降部1例.本组行单纯穿孔修补术7例,包括:开腹修补5例,腹腔镜下修补2例.其中,因吻合口瘘二次开腹行胃空肠吻合术1例,行切除穿孔部位肠段行胃十二指肠吻合术1例.8例患儿手术顺利,均痊愈出院.术后切除组织病理检查报告:十二指肠溃疡4例(幽门螺杆菌均为阴性),其余为炎性细胞浸润及坏死组织.本组术后均内科口服奥美拉唑、铝碳酸镁治疗6～8周.4例术后一周左右做13C呼气试验均为阴性.全部患儿获随访,随访时间2个月至7年,8例均未见慢性腹痛等症状,生长发育良好;5例术后行胃镜检查未见溃疡发生.结论 婴幼儿十二指肠穿孔病因复杂,溃疡穿孔是其主要原因,非甾体抗炎药(NSAIDs)、激素、化疗药物、全身感染等因素可导致胃肠溃疡发生.婴幼儿十二指肠穿孔常缺乏典型症状体征,腹部X线平片、彩色超声、腹腔穿刺、CT等检查有助于术前诊断.十二指肠修补术是婴幼儿十二指肠穿孔安全、有效的手术方式.

abstractsObjective To explore the causes,diagnosis and surgical management of duodenal perforation in infants.Methods The medical records were reviewed retrospectively for 8 infants with duodenal perforation from January 2010 to December 2017,There were 6 boys and 2 girls aged (20.3±9.3)(9-34)months.The mean onset time was (3.5 ± 1.2)(2-6)days.Four infants revealed typical signs of peritonitis.Two cases had a large amount of air below both domes of diaphragm on plain abdominal radiography.Diagnostic abdominocentesis yielded slightly green clear liquid in 4 cases.Results Intraoperative inspection revealed one perforation site in all 8 cases. Perforation site was in duodenal bulb (n=7)and descending duodenum (n=1 ).Operations included primary repair (n=7 ) (including 5 open repairs, 2 laparoscopic ) and duodenal resection &gastroduodenostomy (n=1 ).One case of anastomotic leak healed after redo gastroj ej unostomy (open-repair). All recovered and discharged uneventfully. Postoperative pathological report showed 4 patients had duodenal ulcer (Helicobacter pylori negative ) while others had inflammatory cell infiltrate and necrotic tissue.In 4 patients,13C breath tests were performed postoperatively for H. Pylori and the results were negative.All infants remained healthy without any sequel during a follow-up period of 2 months to 7 years.Five infants were normal under gastroscope.Conclusions The pathogenesis of duodenal perforation is rather complicated in infants.One major cause is peptic ulcer disease. Some drugs, such as nonsteroidal anti-inflammatory drugs or corticosteroids, chemotherapeutic agents and systemic infections are implicated as causative risk factors.Difficulty diagnosis of perforated duodenal ulcer in infants is due to a lack of unconspicuous symptom.It may be improved by plain abdomen radiography, ultrasound, computed tomography and diagnostic abdominocentesis.Simple closure of duodenal ulcer perforation is both safe and effective.