新生儿胃穿孔24例临床分析

目的探讨新生儿胃穿孔的发病原因、诊治措施及治疗效果。方法收集2015-06—2018-06间郑州大学附属儿童医院收治的24例新生儿胃穿孔的临床资料,进行回顾性分析。结果 24例患儿均在入院3 h内行急诊剖腹探查术和胃穿孔修补术。术后病理检查证实穿孔处胃壁肌层缺损。穿孔位于胃底部9例,胃大弯7例,胃后壁5例,胃小弯3例。其中3例合并先天性肠旋转不良,1例合并环状胰腺,1例合并气管食管瘘,2例合并十二指肠隔膜。经手术治疗22例患儿痊愈出院。其中男17例,女5例。早产儿16例,足月儿6例。体质量正常患儿19例,低出生体质量患儿5例。2例因术后严重呼吸衰竭、感染性休克死亡,存活住院时间15 d。结论先天性胃壁肌层缺损主要由胃壁发育缺陷引起,胃内压增高是穿孔的诱因,是导致新生儿胃穿孔的主要原因。及早确诊和手术探查、积极围术期治疗是提高治愈率的关键。术中探查时应注意是否合并先天性肠旋转不良、环状胰腺、十二指肠隔膜等疾病,避免遗漏而导致二次手术。     

新生儿胃壁肌层缺损11例诊治分析

本文总结了十年来11例新生儿胃壁肌层缺损引起新生儿胃穿孔病例,存活率45.5％。分析了新生儿胃穿孔死亡率较高的原因。强调应在确诊后短期内积极做好术前准备,及时手术治疗。认为新生儿的出生胎龄、起病至手术治疗时间、术前体温情况及血pH值以及有无其它合并症直接影响患儿的预后。     

50例急性胃穿孔手术治疗分析

目的探讨急性胃穿孔的临床特点与手术治疗效果。方法回顾性分析手术治疗的50例急性胃穿孔患者的临床资料。结果 50例均痊愈出院,其中单纯修补缝合术31例,胃大部切除术16例,修补术后行胃癌Ⅱ期根治术3例。术后并发症发生率为12.0%(6/50),其中肠梗阻3例,切口感染2例,肺部感染1例。结论急性胃穿孔应尽早明确诊断,掌握手术适应证并把握手术时机,可有效提高手术效果,降低并发症发生率。     

腹部近期再手术的原因分析

自1997至2002年,本院共行腹部手术1750例,近期再手术14例。为总结经验教训,分析如下。1临床资料1.1一般资料:本组男8例,女6例;年龄12～68岁。脾切除术后再行肠修补术1例,胆总管残余结石2例,胃后壁刀伤1例,胆总管囊肿十二指肠吻合术后发生胆漏1例,肝破裂修补后胆道大出血1例,胃癌根治术后腹腔内出血1例,毕氏Ⅱ式胃大部切除术后输入襻梗阻1例,胃穿孔修补术后行胃癌根治术2例,外伤性肠穿孔术后肠梗阻1例,阑尾炎术后腹腔感染1例,胃穿孔及胆总管结石术后切口裂开各1例。1.2治疗方法及结果:本组再行肠修补术1例,肠切除术1例,胆总管切开取石术2例,…     

外伤性胃穿孔30例诊断和外科治疗

目的 探讨外伤性胃穿孔的临床特点与诊治。方法 回顾性分析30例外伤性胃穿孔患者的临床资料,全部均行手术治疗,其中胃穿孔修补术28例,胃部分切除胃空肠吻合术2例。结果 治愈27例,死亡3例,病死率10％。结论 开放性损伤是外伤性胃穿孔常见的致伤原因,合并伤常见。手术是外伤性胃穿孔的主要治疗手段,以缝合修补为主。术中应注意胃贯穿性与后壁穿孔及其他脏器的合并伤的处理。     

腹腔镜胃穿孔修补术治疗胃穿孔对炎症因子的影响

目的:探讨腹腔镜胃穿孔修补术治疗胃溃疡并发胃穿孔的临床效果及对血清白细胞介素-6、肿瘤坏死因子-α、超敏C反应蛋白水平的影响。方法:选取胃溃疡并发胃穿孔的120例患者进行回顾性研究,其中63例行腹腔镜手术(腹腔镜组),57例行传统开腹手术(开腹组),分析两组患者手术相关指标、血清胃泌素及炎症因子水平、手术并发症情况。结果:腹腔镜组术中出血量、手术切口长度、术后肛门首次排气时间、住院时间均低于开腹组(P0.05);术后24 h、72 h,腹腔镜组血清胃泌素水平、炎症因子水平均优于开腹组(P0.05);两组手术并发症发生率差异无统计学意义(P0.05)。结论:腹腔镜胃穿孔修补术治疗胃溃疡并发胃穿孔的临床效果肯定,术后患者胃肠道功能恢复更快,炎症反应更轻。     

腹腔镜修补术治疗急性胃穿孔的临床体会

目的:探讨腹腔镜与开腹修补术治疗急性胃穿孔的临床疗效。方法:选取2015年1月至2018年10月收治的56例胃穿孔患者,分别行腹腔镜修补术(腹腔镜组)与开腹修补术(对照组),每组28例。对比分析两组治疗效果、手术时间、术中出血量、胃肠功能恢复时间及术后肠梗阻、肺部感染、切口出血等并发症发生率。结果:两组治疗总有效率差异无统计学意义(P>0.05)。腹腔镜组手术时间、术中出血量、胃肠功能恢复时间、术后并发症发生率、住院时间优于对照组(P<0.05)。结论:腹腔镜修补术治疗胃穿孔的临床疗效显著,可有效缩短术中操作时间,术后康复快,并发症较少。     

食管癌切除术后少见并发症的诊断与治疗

目的探讨食管癌切除术后少见并发症的原因及诊治体会。方法对山东省成武县人民医院胸外科1995年3月至2012年12月收治的食管癌切除术后少见并发症14例临床资料进行回顾性分析。结果食管癌术后功能性胃排空障碍9例,胸腔胃穿孔2例,远期膈疝2例,吻合口主动脉瘘1例。结论食管癌切除术后功能性胃排空障碍治疗的关键是早期诊断,及时行胃肠减压、药物调理、营养支持等治疗,效果是确切的。胸腔胃穿孔的发生与手术操作技术有关,术后早期发生,应与吻合口瘘鉴别,宜及时二次开胸修补。术后并发膈疝较少见,与膈肌缝合不严密、术后胸腹压增高等因素有关,一经确诊,手术是唯一的治疗方法。吻合口主动脉瘘多继发于吻合口瘘的基础上发生,病情凶险,出血量大,短时间内可致患者死亡。     

腹腔镜胃穿孔修补术的临床应用及疗效观察

目的:探讨腹腔镜手术治疗胃穿孔的疗效。方法:回顾分析2016年1月至2020年12月收治的67例胃穿孔患者的临床资料。将患者分为研究组(n=35,腹腔镜穿孔修补术)与对照组(n=32,开腹手术),对比分析两组术中出血量、手术时间、胃肠功能恢复时间、住院时间及术后肺部感染、切口感染、盆腔脓肿等并发症发生率。结果:与对照组相比,研究组术中出血量少,手术时间、术后胃肠功能恢复时间、住院时间短,术后切口感染率低,两组差异有统计学意义(P0.05)。结论:腹腔镜穿孔修补术治疗胃穿孔的临床疗效显著,术后康复快,并发症少,值得临床应用。     

胃代食管术后胸胃穿孔的病因及治疗

目的探讨食管切除胃代食管术后近期胸胃穿孔的病因及治疗措施.方法对胸胃穿孔和胸食管胃吻合口瘘各16例的发病原因、临床诊断特点和治疗进行对比分析.结果二次开胸术中见16例为吻合口区外之胃壁局限性坏死穿孔或撕裂,其中8例源于胃受挫压或大块结扎后缺血坏死,5例为缝针穿透胃壁全层,3例为胃大小弯角包埋欠妥.全部采用穿孔区修补或加生机组织覆盖.15例手术成功,术后未再发瘘.结论胸胃穿孔的原因与手术技术操作相关,术后早期发生,宜尽早二次开胸修补,成功率达93.8%.     

'Spontaneous' neonatal gastric perforation: is it really spontaneous?

BACKGROUND/PURPOSE: Most historical reports have described gastric perforation in the neonatal population as "spontaneous." More recently, several variables, including prematurity and nasal ventilation, have been implicated as contributing factors. The authors sought to analyze the etiology, course, and outcome of newborns with spontaneous gastric perforation from one institution over a 16-year period. METHODS: The authors reviewed retrospectively the charts of all infants who underwent operation or had perforation of the stomach diagnosed in the newborn period. RESULTS: Among more than 84,000 live births, 7 newborns were identified with perforation of the stomach. Four had coexisting gastrointestinal lesions (2 necrotizing enterocolitis, 1 undiagnosed tracheoesophageal fistula, 1 meconium plug), and 1 received nasal continuous positive airway pressure (CPAP). In only 2 cases were no other gastrointestinal lesions or other presumed contributing factors (nasal CPAP) present, and thus, only 2 cases could be classified as "spontaneous." Mortality rate was 57%. Three of the patients were premature, all of whom died. CONCLUSIONS: Whereas in the older literature, most cases of gastric perforation were considered spontaneous, and were full term, the authors' review of 7 cases over a 16-year period leads us to question the cause as spontaneous. The authors found that prematurity and concomitant gastrointestinal lesions were associated with gastric perforation in the neonate and that few cases truly are spontaneous. The authors suggest that when gastric perforation occurs in neonates, a contributing cause should be sought.     

假性胰腺囊肿致胃后壁穿孔11例报告

目的总结假性胰腺囊肿致胃后壁腐蚀性穿孔的临床诊治经验,探讨手术时机和手术方式。方法回顾性分析2001年8月-2006年12月手术治疗11例假性胰腺囊肿致胃后壁腐蚀性穿孔的临床资料,均为胆源性重症急性胰腺炎保守治疗4-6周患者,术前均行胃镜及CT检查而确诊;均行胆囊切除,胆总管探查T管引流,胃后壁穿孔部位环形缝扎,胃网膜囊肿内引流,胃前壁胰体尾囊肿吻合术。结果11例手术均获成功,术后1年复查胃镜及上腹部CT发现穿孔及囊肿均已痊愈。结论①胃后壁穿孔环形缝扎胃网膜囊肿内引流,胃前壁胰体尾囊肿吻合术是早期一次性手术治疗假性胰腺囊肿所致胃后壁穿孔的有效手术方式。②胃镜检查、CT检查是明确诊断、手术决策及预后评估的有效手段。③假性胰腺囊肿形成4-6周内实施内引流手术是安全有效的。     

Traumatic diaphragmatic hernia. Report of 50 cases

The writers report a clinical series of 50 patients with traumatic diaphragmatic hernia. There were 36 hernias on the left side and 14 on the right. Stab or bullet wound was the cause of the hernia in 27 cases. The other 23 cases were due to traffic accidents or other blunt injuries. Immediate operative repair was done in 30 cases; in 20 cases the operation was carried out after a time interval of 11.5 years post trauma on an average. Plain chest X-ray, barium meal or enema and pneumoperitoneum were the most valuable diagnostic tools. Visceral injuries were discovered in 53% of cases caused by traffic accidents. The omentum, stomach, colon and spleen were the organs most frequently herniated. In two cases perforation of the stomach occurred before the operation. There were three cases of pericardial rupture associated with the diaphragmatic hernia in the series. The repair was done via thoracotomy in 28 cases, via laparotomy in 4 cases; and both thoracotomy and laparotomy were carried out in 18 cases. The hospital mortality was 2%. One of the patients died of peritonitis and renal failure following perforation of the stomach and intestines on the 9th postoperative day. Recurrence of the hernia occurred twice in one case. Re-examination revealed striction of the diaphragmatic movement in 11 cases. The clinical features, diagnosis and operative treatment are discussed.     

Traumatic rupture of the oesophagus and stomach

Thirty-nine cases of traumatic perforation of the oesophagus or stomach have been studied. Thirty-two of the perforations followed oesphagoscopy, five were `spontaneous,' and two were due to damage by a foreign body. Eight of the perforations occurred in the cervical oesophagus, 22 in the thoracic portion, and nine were in either the abdominal oesophagus or the stomach. Treatment was of two types—either operative closure of the perforation or a conservative routine of intravenous fluids, parenteral antibiotics, and cessation of oral feeding. In some patients treated conservatively, drainage procedures were also carried out. Five patients with terminal carcinoma, in whom oesophageal intubation after prolonged dysphagia caused perforation, had no treatment apart from analgesics and sedatives. Several of the patients treated by surgical closure had a concurrent definitive operation (resection of carcinoma in four cases and myotomy for achalasia in two cases). Fourteen of the 21 patients treated by repair or resection of the perforation survived. Ten of the 13 treated conservatively also survived. The good results of conservative treatment for cervical perforations appear to make it the treatment of choice. Only an occasional case of thoracic perforation is suitable for conservative treatment, and as a general rule perforations in this area and in the peritoneal cavity should be treated surgically.     

Emergency oesophagectomy

In the treatment of instrumental perforation of the obstructed thoracic oesophagus, relief of obstruction is one of the prerequisites of success. In some cases it is better to resect both the perforation and the original lesion rather than to rely on repair and drainage. The salient features of 19 cases of emergency oesophagectomy collected from the literature have been tabulated, and three new examples are here reported. The results are encouraging. The operation usually performed for malignant cases is a one-stage oesophagogastrectomy with oesophagogastrostomy; a two-stage procedure is recommended for benign lower-end strictures. The lacerated oesophagus and the stricture are resected at the emergency operation, and the fundus of the stomach, advanced into the chest, is anastomosed to the oesophagus. The whole of the stomach is thereby preserved for the elective reconstruction which constitutes the second stage.     

腹腔镜消化性溃疡穿孔修补术23例

目的探讨腹腔镜消化性溃疡穿孔修补术的方法和治疗效果. 方法应用腹腔镜对23例消化性溃疡穿孔(十二指肠穿孔17例,胃窦部前壁穿孔5例,胃体部小弯侧穿孔1例)行穿孔修补﹑腹腔引流术. 结果手术均获成功,无手术并发症.3个月后胃镜复查,13例使用丝线者均有缝线外露,10例使用可吸收外科缝线者无缝线外露.随访6～27个月,平均18个月,3例十二指肠球部穿孔者仍有轻度嗳气,返酸,余无明显症状,无再穿孔. 结论腹腔镜消化性溃疡穿孔修补术安全可靠,术后继续正规内科治疗,效果满意.     

A report of an atypical case of Degos' disease with multiple perforations of the stomach and small intestine

A 47-year old male complaining of severe abdominal pain associated with distention was admitted to our department on August 5, 1986. His first admission to our hospital was 18 days previously for leg pain and fever. He underwent emergency operation with a preoperative diagnosis of acute peritonitis due to perforation of gastric ulcer. Operative findings showed one perforation of the stomach and two of the ileum. Distal gastrectomy, enterectomy and peritoneal drainage were carried out. Resected specimen revealed six ulcers, two of them in the stomach, four in the ileum. Microscopic examination disclosed intimal proliferations of small arteries in the mucosal layer. The vessels near the ulcers were most severely involved but the same changes were also found in the subserous layer and mesentery. It was suggested that the multiple ulcers were secondary to vascular lesions identical to the gastrointestinal lesion of Degos' disease. Postoperative examinations revealed one ulcer in the jejunum and another in the descending colon. Ten months after operation he lives with no complaint on the gastrointestinal tract. Only 80 cases of Degos' disease have been reported in the western countries and 10 cases in Japan. In those atypical cases of Degos' disease without papulosis were only Manuel's and ours.     

基层医院开展腹腔镜胃手术的应用体会

目的:探讨基层医院应用腹腔镜手术治疗胃疾病的可行性与手术方法,并评估其临床应用价值。方法:回顾分析2006年1月至2009年6月为20例胃疾病患者行腹腔镜手术的临床资料。结果:19例腹腔镜手术获成功,1例胃穿孔患者快速病理示恶变遂中转开腹,无肠粘连、残端漏等并发症发生。手术平均时间(203.2±52.5)min,术中平均出血(235.6±95.7)ml,术后平均住院(8.0±1.6)d。随访3~24个月,患者均恢复良好。结论:腹腔镜胃手术定位准确,安全、可靠,患者创伤小,康复快,疗效确切,尤其适于早期胃癌及胃良性疾病者。     

腹腔镜在胃肠道穿孔手术中的应用体会(附20例报告)

目的:总结腹腔镜手术治疗胃肠道穿孔的手术方法及应用价值。方法:回顾分析为20例胃肠道穿孔患者行腹腔镜手术的临床资料。术中探查腹腔,吸净腹腔积液,行穿孔修补术。结果:19例顺利完成腹腔镜手术,1例胃穿孔患者术中见胃壁僵硬发白,冰冻检查确诊为胃癌,遂中转开腹行胃癌根治术(D1)。手术时间60～120 min,平均90 min;术后48～96 h恢复胃肠蠕动后拔除胃管、引流管、尿管,开始进流质饮食,并逐渐恢复正常饮食。术后无并发症发生。术后3个月行胃镜、结肠镜检查及全消化道钡餐透视,随访6～12个月,无一例复发或明显异常。结论:腹腔镜胃肠道穿孔修补术操作简单、安全、效果确切,不受患者肥胖因素影响,可充分吸净腹腔内积液,减少了术后腹腔、盆腔脓肿的发生,对腹腔脏器干扰小,术后粘连性肠梗阻发生率低;同时可明确诊断,避免了盲目开腹手术切口相关并发症的发生,较传统开腹手术更具优越性,值得临床推广。     

泛影葡胺造影在诊断上消化道穿孔中的应用

目的：探讨泛影葡胺造影对上消化道穿孔者的诊断价值。方法：对临床上怀疑上消化道穿孔的112例患者,术前使用泛影葡胺造影,并对该组的临床资料进行回顾性分析。患者在透视下动态观察有无造影剂经胃、十二指肠漏出并摄片分析,有造影剂漏出为阳性,无则为阴性。结果：112例患者行泛影葡胺造影,阳性者72 例：胃穿孔31 例,其中胃溃疡穿孔27例,胃癌穿孔4例;十二指肠球部穿孔 41例。阴性者40例,其中39例经CT、急诊胃镜检查及剖腹探查确诊为其他疾病,但有1例阴性者行剖腹探查诊断为胃后壁穿孔。该法的诊断符合率99.1 %,敏感性98.6%,特异性100%,全组假阴性1例,无假阳性。结论：泛影葡胺在诊断上消化道穿孔中安全、有效、方便、价廉,有其重要应用价值。