内镜观察肠内营养缺失对儿童旷置结肠炎的影响

目的 探讨肠内营养缺失对小儿旷置结肠炎发生发展的影响,以及小儿旷置结肠炎的内镜特点.方法 收集1999年9月至2008年12月住院的126例旷置结肠炎患儿的临床及内镜检查资料,通过对患儿术前有无感染疾患、造口不同术式、术后有无症状、结肠旷置持续时间、造口关闭后炎症消失等因素进行分析,了解肠内营养缺失对小儿旷置结肠炎发生发展的影响.结果 126例患儿按不同因素分类对照比较内镜观察结果,检出旷置结肠黏膜糜烂、溃疡、炎性息肉阳性率,有临床症状病例高于无临床症状者(P<0.05),旷置时间>3个月病例高于旷置时间<3个月者(P<0.05);阳性检出率高低与术前有无感染疾患、造口不同术式两因素无关(P>0.05);85例患儿造口关闭3个月后内镜追踪检查,旷置结肠炎自愈.结论 肠内营养缺失是小儿旷置结肠炎发生发展的主要原因之一,内镜检查有利于小儿旷置结肠炎早期诊断与对症治疗.     

小儿结肠息肉86例临床分析

目的 总结小儿结肠息肉的诊治经验,探讨电子结肠镜下诊治小儿结肠息肉的方法.方法回顾性分析86例结肠息肉患儿的诊治经过.男59例,女27例,主要表现为间断性血便,均行结肠镜下圈套法高频电凝结肠息肉切除术.结果 86例中,1例全结肠布满大小不一息肉,其余85例共检出息肉90枚,其中1例3枚,3例2枚,80例均为1枚.90枚息肉分布于直肠43枚,乙状结肠37枚,降结肠10枚.病理检查结果回报,幼年性息肉84例,腺瘤样息肉2例.2例术后出血经保守治疗好转,无肠穿孔病例.随访3个月至3年所有患儿便血症状消失.结论 小儿结肠镜检安全,疗效可靠,内镜下圈套法高频电凝结肠息肉切除术是治疗小儿结肠息肉的安全有效的方法.     

仿真CT肠镜与大肠镜在小儿外科的应用

目的 对仿真CT肠镜与大肠镜在小儿外科的应用进行比较。方法 对33例患儿采用日本Olympus PCF20大肠镜及美国GE公司Hispead型螺旋CT仿真大肠镜进行检查。大肠镜检查使用Endoview软件记录内镜图像，完毕后再进行CT检查，使用Insight软件进行CT三维图像重建，利用Modify Endoscopy程序显示肠腔内的形态结构。结果 本组33例患儿，仿真CT肠镜（CTVE）检出肠重复畸形2例，肠旋转不良3例，结肠冗长症5例，大肠息肉10例（漏诊5例），溃疡性结肠炎、大肠血管畸形未能检出；大肠镜检出肠放置不良2例（漏诊1例），结肠冗长症5例，大肠息肉15例，溃疡性结肠炎6例，大肠血管畸形2例，肠重复畸形未能检出。仿真CT肠镜对诊断肠道畸形具有较高的准确性，但对于直径小于0.5cm的大肠息肉、肠血管畸形检出率低，易漏诊；对小儿溃疡性结肠炎的粘膜显示不理想。大肠镜则对于诊断大肠息肉、溃疡性结肠炎、大肠血管畸形有较高的准确性。结论 仿真CT肠镜是诊断肠道畸形的一种有效途径，但是对肠道粘膜的病变的显示不理想；是大肠镜检的一种重要补充手段。     

婴幼儿过敏性结肠炎临床特点及其肠黏膜中嗜酸粒细胞阳离子蛋白的表达

目的研究婴幼儿过敏性结肠炎的临床特征及其肠黏膜组织中嗜酸粒细胞阳离子蛋白(ECP)的表达。方法回顾分析2011年9月—2014年2月收治的24例过敏性结肠炎患儿的临床资料;采用免疫组织化学染色法检测和比较24例过敏性结肠炎患儿肠黏膜及16例幽门螺杆菌感染患儿的胃和十二指肠黏膜组织,以及18例先天性巨结肠患儿肠切除术后近端正常的肠黏膜中ECP表达的差异。结果 24例过敏性结肠炎中男15例、女8例,婴儿23例,6月龄20例;临床表现均有血便,其次为腹泻15例。1例有湿疹,3例有药物过敏。内镜下病变主要累及乙状结肠(12例)及直肠(11例),最常表现为黏膜红斑(21例)、痘疹样结节(18例)、糜烂(3例)及溃疡(3例)等;组织病理学表现为黏膜嗜酸性粒细胞浸润。过敏性结肠炎患儿肠黏膜ECP阳性嗜酸性粒细胞个数为42(30~60),幽门螺杆菌感染患儿为18(15~23),先天性巨结肠患儿为25.5(14~35),三组间差异有统计学意义(H=28.14,P0.001)。结论儿童过敏性结肠炎以婴幼儿多见,内镜下主要表现为黏膜红斑及痘疹样结节。肠黏膜组织中ECP阳性嗜酸性粒细胞数增加是过敏性结肠炎的特征性表现。     

纤维结肠镜在小儿下消化道出血中的应用(附83例报告)

本文分析了我院1982年1月至1986年10月,83例12岁以下因下消化道出血的小儿进行纤维结肠镜检查结果,全部病例使用成人纤维结肠镜检查,在非X 线透视下操作。检出结肠癌1例,慢性直、结肠炎11例,溃疡性结肠炎3例,阿米巴痢疾1例,家族性息肉病3例,直、结肠息肉54例,未见异常10例。均未发生并发症。并对术前肠道准备、用药、操作方法及插入深度以及息肉的处理等加以讨论。     

小儿大肠息肉39例临床分析

小儿消化道息肉好发于结肠,尤其是直肠。肠息肉是较多见病之一。最近由于内窥镜的发展,使诊断率大大提高,在小儿利用内窥镜息肉切除已开始普及。病例1980年～1990年10年间收治小儿直肠、结肠息肉39例,男22例,女17例。年龄2个月～15岁,1岁以下2例,1～5岁26例,6～9岁8例,10岁以上3例。全部病例息肉数均为1个。发生部位在直肠21例、乙状结肠9例、降结肠4例、横结肠5例。血便26例为数最多。有2例息肉自然脱落时发生大量出     

新型成人结肠镜在儿科临床的应用

为了解新型成人结肠镜在儿科临床应用的效果，自１９８９年１月～１９９５年１２月应用成人纤维结肠镜和成人电子结肠镜对１９８例１２岁以下有腹痛、便血症状的患儿进行了诊断和治疗性镜检。检查过程中有８０％病例可顺利到达回盲部，有９７例经结肠镜切除结肠息肉１１３枚，其中１０９枚用内镜下电凝电切息肉，另４枚用内镜下激光治疗息肉，未出现穿孔、出血等并发症。在同期结肠镜检查的病例中，小儿结肠镜检的阳性率略高于成人结肠镜检查的阳性率。提示：在结肠镜检查和治疗中只要注意操作方法和严格掌握结肠镜下的治疗原则，使用新型的成人纤维结肠镜和成人电子结肠镜同样是安全和可靠的。     

小儿下消化道出血疾病临床分析（附59例纤维结肠镜检查）

目的 探讨纤维结肠镜对小儿下消化道出血性疾病的诊断价值。方法 对59例下消化道出血疾病患儿的结肠镜检查资料进行分析。结果 结肠及直肠息肉29例(49．2％，其中全结肠多发性息肉2例)，乙状结肠及直肠炎症6例(10．2％)，肛周疾病23例(38．9％，肛周炎4例，肛裂19例)，直肠黏膜脱垂1例(1．7％)。结论 消化道息肉是小儿下消化道出血的主要原因。     

先天性巨结肠术后肠炎的结肠镜下特征分析

目的 探讨小儿先天性巨结肠(HD)术后小肠结肠炎(EC)的结肠镜下表现及其与手术因素的关系.方法 我院238例HD术后患儿随访1～8年,其中临床诊断为EC者45例,均行结肠镜检查.观察EC的结肠镜下表现,并将EC组与非EC组其他手术并发症的发生率进行比较.结果 肠镜观察EC,近吻合口结肠表现为黏膜水肿质碎、充血、大片糜烂,9例合并溃疡;远离吻合口结肠主要表现为黏膜充血水肿,点片状糜烂,3例合并溃疡;吻合口周围结肠炎症较回肓部重(P＜0.01).EC组其他手术并发症17例(吻合口病变8例,复发3例,解剖异常6例),非EC组13例(吻合口病变7例,复发1例,解剖异常3例);EC组手术并发症发生率37.8％高于非EC组6.7％(P＜0.01).结论 HD合并手术并发症者,EC发生率高;可能因手术并发症引起病变主要集中在吻合口及周围结肠,肠镜观察EC表现为近吻合口周围结肠炎症较重,远离吻合口逐渐减轻.     

婴幼儿溃疡性结肠炎13例

目的 总结婴幼儿溃疡性结肠炎(UC)临床特征，以提高对此病的认识。方法 对13例婴幼儿溃疡性结肠炎的内镜表现、活检结果、临床特征等进行分析。结果 婴幼儿溃疡性结肠炎13例，占本院同期溃疡性结肠炎46％，多数起病急，主要表现为反复腹泻，大便为黏液血便、脓血便及便血，部分有发热，一般情况较差，腹痛等不明显，贫血、营养不良较突出，且并肛周病变。内镜下病变呈连续性分布，黏膜弥漫性充血、水肿，血管纹理模糊，质脆，易出血，有颗粒样改变并可见多发糜烂及浅表溃疡；少数见假息肉。结论 婴幼儿溃疡性结肠炎在儿童中占有一定比例，误诊率高，临床上不容忽视。结肠镜及黏膜活检是目前确诊UC最可靠的方法。     

Diagnostic and therapeutic colonoscopy in children: experience from a pediatric gastroenterology centre in India.

Eighty colonoscopies were performed in 72 children suffering from various colonic disorders. The indications for colonoscopic examination were bleeding per rectum (83.3%), prolonged colitis (14.0%) and colonic obstruction (2.7%). Total bowel wash with normal saline was very good for colonic preparation in majority of the cases. Pediatric colonoscope (PCF-Olympus) was used and the procedure performed under sedation with intravenous diazepam and pentazocine. Juvenile polyps were the commonest lesions (69.4%). Diagnosis of idiopathic ulcerative colitis, acute colitis, tuberculous colitis, amebic colitis and allergic colitis was made in 5.5, 4.2, 2.7, 1.3 and 1.3% cases, respectively. Tuberculous hypertrophic lesion and tuberculous stricture was seen in one case each. The commonest site of juvenile polyps was rectosigmoid region. Ninety per cent of them were single, 8% had polyps ranging from 2-4 in number and one (2%) child had juvenile polyposis coli. Successful colonoscopic removal of polyps with polypectomy snare was possible in 96% cases. No complications were observed. Colonoscopy is a safe and useful mode of investigation of colonic disorders in expert hands. It has a great therapeutic value in childhood.     

Colorectal adenocarcinoma as a second malignant neoplasm following Wilms' tumor and rhabdomyosarcoma

Colorectal carcinoma is one of the most common primary malignancies in adults and occurs in older patients after pelvic radiation. It is rare in children and young adults. We report two cases of colonic adenocarcinoma which were second malignant neoplasms following treatment for early childhood malignancies. One child had Wilms' tumor at 9 months of age treated with preoperative radiation and surgery. He developed radiation colitis and multifocal intestinal adenocarcinomas 42 years later and died with abdominal carcinomatosis. The second child had retroperitoneal embryonal rhabdomyosarcoma at age 1 year and was treated with preoperative radiation, surgery, and chemotherapy. At age 2 years he had radiation colitis; at age 11 years he had rectal adenocarcinoma associated with adenomatous polyps, focal adenomatous change and radiation colitis. Immunohistochemical studies revealed p53 positivity in both adenocarcinomas and in adenomas from the second patient, suggesting that p53 mutation was involved in carcinogenesis. The history of high-dose radiation in early childhood and the multifocal lesions suggest the adenocarcinomas in both patients were second malignant neoplasms, with associated reactive and benign neoplastic and premalignant lesions well documented in one case. These two cases document the phenomenon of early onset of adult type tumors in survivors of childhood cancer and emphasize the need for continued clinical evaluation of patients at risk for second malignant neoplasms. © 1996 Wiley-Liss, Inc.     

小儿输尿管息肉致梗阻性肾积水

目的探讨小儿输尿管息肉致梗阻性肾积水的临床特点及诊治方法。方法回顾分析1987～2005年收治33例小儿输尿管息肉致梗阻性肾积水的临床资料，男32例，女1例，左侧27例，右侧5例，双侧1例。就诊年龄5～14岁，平均9岁，病程1个月至5年，平均1年7个月，发病年龄4～12岁，平均7岁。结果33例患儿行手术治疗，手术及术后病理证实肾脏积水为输尿管息肉造成梗阻所致，术后6～12个月行IVP检查，肾积水缓解或减轻，腹痛症状消失，随访6个月至18年未见息肉复发。结论输尿管息肉致梗阻性肾积水以男孩多见，且以学龄儿童为主，多发生在左侧，临床表现和其他原因引起的肾积水类似，但腹痛较剧烈，积水多不重。治疗根据息肉的位置及大小决定手术方案，包括息肉段输尿管切除＋肾盂输尿管吻合，及息肉段输尿管切除＋输尿管一输尿管吻合。     

Lymphonodular hyperplasia of the colon as a pathologic finding in children with lower gastrointestinal bleeding

The serious implication of gastrointestinal blood loss in children is well recognized; however, the significance of lymphonodular hyperplasia of the colon (LNHC) as a pathologic finding in this group of children is unclear. We reviewed the records of 95 children, ages 2-48 months, who were referred to our clinic with a history of hematochezia. Proctosigmoidoscopy was performed on 65 of them. Twenty children (31%) examined proctosigmoidoscopically were found to have LNHC, with no other identified source of bleeding. Clinical histories, endoscopic findings, and colonic biopsy specimens from the LNHC group were examined. Clinical presentation of patients in this group was not distinctive. LNHC was most prominent in the distal colon and rectum and was endoscopically characterized by friability (13/20) and ulceration (3/20). Characteristics of biopsy specimens from children with LNHC were than compared with tissue obtained from an age-matched control population and children with colitis. Biopsy specimens from children with LNHC contained increased numbers of lymphoid follicles and larger follicles than those from the control group. Specimens also contained mucosal inflammation and epithelial thinning and ulceration overlying enlarged follicles. We conclude that LNHC is a frequent proctosigmoidoscopic finding in children evaluated for lower gastrointestinal bleeding. The endoscopic and histologic appearance of these lesions would suggest that LNHC is not a normal finding and represents a potential source of rectal bleeding in children.     

Some reservations about clinical guidelines.

Prewarmed saline enemas and transabdominal ultrasound (hydrosonography) were used to evaluate 17 consecutive children with rectal bleeding before colonoscopy. Twelve patients with polyps were identified (10 by ultrasound, 10 by endoscopy): these included multiple hyperplastic polyps (1), multiple polyps (1), solitary polyps (9), and pseudopolyps (1). Ultrasound identified 11 polyps in 10 patients, missing two patients with small polyps less than 0.5 cm in diameter. The polyps were hyperechoic ovoid masses fixed to the colonic wall, with a stalk (7), submucosal infolding (5), and intraluminal floating (5). There was one false positive. Colonoscopy was refused by one patient and failed to reach beyond the distal sigmoid in another following previous surgery for malrotation. Colonoscopy was superior in identifying finer mucosal detail (colitis, ulcers, proctitis, anal fissure) and in detecting smaller polyps (sessile polyps, hyperplastic polyps). Hydrosonography of the colon is a simple, relatively non-invasive procedure that provides an alternative, radiation-free examination of the whole colon before colonoscopy. It is complementary to colonoscopy in the management of rectal bleeding in children.     

Gastric polyps and nodules in children receiving long-term omeprazole therapy

OBJECTIVE: Multiple gastric polyps have been reported to occur in adults receiving omeprazole therapy. There are little published data in children. We report our experience in monitoring the gross and histologic appearance of the stomach in children receiving long-term omeprazole therapy. METHODS: This was a retrospective review of the charts of children who received omeprazole for more than 6 months for reflux esophagitis between 1989 and 1998. All patients had repeated endoscopic examinations until healing of the esophagitis was confirmed and then annually thereafter. At endoscopy, gastric mucosal swellings were classified as polyps or nodules based on histology. RESULTS: Thirty-one children had long-term endoscopic follow-up while receiving omeprazole. Seven of 31 children had gastric polyps and/or nodules, noted between 10 and 48 months (mean = 28 months) of omeprazole therapy. Four had nodules only, one had a sessile hyperplastic polyp, and two had both a polyp (one hyperplastic and one fundic gland polyp) and nodules. All lesions were found in the gastric body. Nodules in four of the six children disappeared spontaneously while the children continued to receive omeprazole. The polyps persisted. There were no dysplastic changes in the gastric mucosa or polyps in any of the patients. There were no significant differences between the 7 children with and the 24 without polyps/nodules with respect to age, gastrin concentrations, or dose and duration of omeprazole therapy. CONCLUSIONS: Gastric polyps and nodules may be found in children receiving long-term omeprazole therapy. The gastric changes in our patients were benign during the mean observation period of 31 months.     

Causes of death and the histopathologic findings in fatal shigellosis

Thirty-seven children (median age, 2 years) with shigellosis in Bangladesh were subjected to postmortem examination to determine causes of death and the spectrum of intestinal histopathology. Infecting species were: Shigella dysenteriae 1, 7 cases; S. dysenteriae 2, 2 cases; Shigella flexneri, 23 cases; Shigella boydii, 4 cases; and mixed infection with Shigella boydii and Shigella sonnei, 1 case. Complicating conditions detected before death included malnutrition in 25 cases, pneumonia in 11 cases and septicemia in 8 cases. In all 37 cases the colon showed gross colitis, consisting of mucosal erythema and edema; superficial ulcerations were visible in 15 cases. Microscopically in the colon the lamina propria showed inflammatory cellular infiltration in 27 cases and crypt abscesses were present in 22 cases. In 9 cases each there were colonic glands in the submucosa and branching of colonic crypts, indicating increased regenerative activity of crypt cells. Severe lesions were mucosal denudation and deep ulceration in 15 cases with a pseudomembrane in 7 and pseudopolyposis in 2 of these patients. The most common underlying cause of death was colitis, whereas the most common immediate and associated causes were, respectively, septicemia and pneumonia. These results indicated that fatal childhood shigellosis results from severe colitis, often complicated by septicemia and concomitant malnutrition and pneumonia.     

Rectal bleeding in Egyptian children

AIM: In a prospective study to outline the aetiology of bleeding per rectum (BPR) in Egyptian infants and children, a subsidiary aim was to define some of the clinical characteristics of the different aetiologies. SUBJECTS AND METHODS: 194 children with BPR are described. The diagnostic work-up included laboratory investigations, radiological and endoscopic assessment, radio-isotope scanning, angiography and histopathological examination of mucosal biopsies, as appropriate. RESULTS: Ages ranged from 3 to 192 months with a mean (SD) of 49.8 (43.5). Infectious enterocolitis was the most common cause (37.1%). Others included colorectal polyps (21.1%), chronic colitis (16%) including inflammatory bowel diseases (5.2%), allergic colitis (2.6%), solitary rectal ulcer syndrome (1.5%) and non-specific colitis (6.7%). Intussusception and Meckel's diverticulae were the cause in 7.3% and 2.6%, respectively, while other aetiologies included vascular (6.2%), systemic (3.6%), local anal (3.1%) and upper gastro-intestinal causes (1.5%). In 1.5% of cases, the cause remained 'obscure'. CONCLUSION: In Egyptian children, infectious enterocolitis followed by colorectal polyps and chronic colitis are major causes of BPR.     

Juvenile polyps and ulcerative colitis

Four children with ulcerative colitis, three of whom were in clinical remission of their disease, experienced rectal bleeding due to solitary juvenile polyps. Only one of the four polyps was detected radiologically. Two children passed their polyps spontaneously, one was identified at colonoscopy, and the fourth caused colocolic intussusception and was removed during surgery.