儿童先天性腹内疝临床特点分析

目的 儿童先天性腹内疝(congenital internal hernias,CIH)是较为少见的疾病.本研究的目的是分析儿童先天性腹内疝的临床特点.方法 回顾性分析北京儿童医院2007年3月至2015年7月间收治的44例先天性腹内疝患儿的临床资料.结果 共有44例患儿被手术证实为先天性腹内疝.其中男24例,女孩20例,男女比例为1.2∶1.患儿的发病年龄为22 h至13岁,平均3.9岁.小于1岁患儿腹内疝共19例,占总例数的43.2％,其中新生儿病例9例占总例数的20.5％.根据手术所见将44例患儿分为3组:十二指肠旁疝(paraduodenal hernia,PH)组2例,肠系膜裂孔疝(transmesenteric hernia,TH)组34例,腹腔内先天性索带所致内疝(hernia due to congenital liga-ment,CLH)组8例.十二指肠旁疝患儿的发病年龄为11.9岁,显著大于肠系膜裂孔疝组3.35岁(P=0.005)和先天性索带致内疝组4.05岁(P=0.009).腹内疝的主要症状包括腹痛(n=31,70.4％)、呕吐(n=35,79.5％)、血便(n=3,6.8％)、腹泻(n=2,4.5％)等;每个临床症状各组间差异无统计学意义.术前有31例患儿接受腹部B型超声检查,其中21(67.7％)例患儿术前超声明确诊断内疝.手术中发现33(75.0％)例患儿有肠管坏死,TH组88.2％ (30/34)的患儿疝人肠管坏死,显著高于PH组(0/2,P=0.024)和CLH组(1/8,P＜0.001).结论 儿童先天性腹内疝是临床上一种少见的疾病.尽管术前很难明确诊断,但及时的手术治疗可取得很好的疗效.

Analysis of clinical characteristics of congenital internal hernia in children

Objective To explore the clinical characteristics of congenital internal hernia (CIH) in childrer.Methods A retrospective review was conducted for medical records of 44 CIH children between March 2007 and July 2015.Results CIH was confirmed intraoperatively in 24 boys and 20 girls.The mean age at presentation was 3.9 years (22 hours to 13 years).There were 19 (43.2％)patients with internal hernias younger than one year old including 9 (20.5％) neonatal patients.They were divided into 3 groups based upon intraoperative findings:paraduodenal hernia (PH,n =2),transmesenteric hernia (TH,n =34) and hernia due to congenital ligament (CLH,n =8).The onset age in PH group was significantly greater than that in TH group (11.9 vs 3.35 years,P =0.005) and CLH group (11.9 vs 4.05 years,P =0.009).The major symptoms of CIH included abdominal pain (n =31,70.4％),vomiting (n =35,79.5 ％),hematochezia (n =3,6.8％) and diarrhea (n =2,4.5％).No statistical difference existed in each clinical symptom among different groups.Thirty-one patients received preoperative ultrasonography and internal hernia was confirmed in 21 patients.Intestinal necrosis occurred in 33/44 (75.0％) patients including 30/34 (88.2％) patients suffering from TH with a significant higher incidence than PH (0/2,P =0.024) and CLH (1/8,P＜0.001).Conclusions Congenital internal hernia in children is a rare clinical condition,Although CIH is difficult to make a definite preoperative diagnosis.Prompt operation yields optimal outcomes.