新生儿胃穿孔一例

患儿男 ,双胎 ,行剖腹产术后第 2天 ,因吸入性肺炎住儿科。第 5天晚患儿哭闹不止 ,次日出现腹胀。查体 :体温 :39 2℃ ,呼吸 :180次 /ｍｉｎ。腹胀如气球 ,全腹叩诊鼓音 ,肠鸣音消失。胸腹Ｘ光片 :双膈下有大量游离气体。诊断腹腔内空腔脏器穿孔并急性弥慢性腹膜炎。急诊行开腹探查术 ,术中发现胃后壁近大弯侧有一长 2ｃｍ的穿孔 ,行胃穿孔修补腹腔引流术。术后第 2天因呼吸衰竭死亡。讨论　新生儿胃穿孔较少见 ,男婴多于女婴 ,病死率为6 5 3%～ 81% [1] 。常见原因是胃壁肌层缺陷、溃疡穿孔、产伤、插胃管等引起。手术以修补为主。本例术…     

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。     

新生儿胃穿孔3例报告

病例1女，足月顺产。出生时有窒息。出生后第3天出现腹胀。呕吐胃内容物，无咖啡样物，第4天转入我院。查体：T36．7℃。P110次／分，R50次／分。体重3．5kg。腹胀明显。肠鸣弱。其余(-)。B超检查示中等量腹水，腹部X线平片示腹腔积气。以“腹腔脏器穿孔并急性弥漫性腹膜炎”及“新生儿窒息”在全麻插管下行急诊剖腹探查术。术中见胃窦后壁有一直径为0．4cm的穿孔。行局部修补、腹腔引流。术后送ICU病房。治愈出院。术后诊断：应激性溃疡穿孔并急性弥漫性腹膜炎。     

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。     

新生儿胃穿孔的治疗

目的:提高新生儿胃肠穿孔的治愈率。方法:总结1983年3月至1997年3月13例经手术证实诊断为胃穿孔的新生儿。分析了影响预后的因素:就诊时间,早期处理.胎龄,体重和有无合并症等。结果:成活6例,死亡7例,死亡率53.8％。结论:积极处理腹膜炎及中毒性休克,加强围术期处理是提高治愈率的关键。     

治愈烫伤并发胃穿孔一例

患者男 ,36岁 ,被沸水烫伤后第 2天入院。一般情况好 ,体温 37.5℃ ,脉搏 90次 /ｍｉｎ ,血压 110 /80ｍｍＨｇ(1ｍｍＨｇ =0 .133ｋＰａ)。烫伤总面积 36 % ,Ⅲ度 30 %ＴＢＳＡ。创面分布于四肢 ,以双下肢为重 ,除烫伤创面外 ,无其他外伤及休克症状。查血 :红细胞 4× 10 12 /Ｌ ,血红蛋白 12ｇ/Ｌ ,白细胞 11× 10 9/Ｌ ;血钾 3.1ｍｍｏｌ/Ｌ ,二氧化碳结合力 2 2ｍｍｏｌ/Ｌ。烫伤创面外用ＳＤ Ａｇ ,及时补液及静脉滴注磷霉素等。入院后第 3天早晨 ,患者自觉口渴 ,喝水后上腹剧痛伴恶心、呕吐 ,呕吐物为胃内容物 ,症状逐渐加重。查体 :…     

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。     

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。     

一例特殊的急性胃穿孔

病例报告患者:男,78岁,1990年1月25日因聚餐后上腹部不适伴呕吐3天,以急性胃炎收入内科。病程中无腹泻、无畏寒发热。既往除有冠心病、高血压病、脑动脉硬化等病外,1987年曾因肝脓肿行手术治疗。体检:体温36.2℃,脉搏82次,呼吸20次,血压22/12kPa。神清,皮肤巩膜未见黄染,心界稍向左下方增大,心尖可闻及收缩期杂音,上腹部可见一不规整手术疤痕,肝脾触诊不满意,未扪及包块,剑突下轻压痛、无反跳痛,肠鸣音稍亢进。实验室检查:白细胞13×10~9/L,中性0.70,二氧化碳结合力20.1mmol/L,尿素氮9.2mmol/L,尿     

腹腔镜胃穿孔修补术14例报告

空腔脏器穿孔一般需要手术处理，手术方式有开腹修补和腹腔镜下修补2种。西部地区基层医院受经济水平所限开展腹腔镜手术较晚，2012年1～12月我科腹腔镜下行胃穿孔修补术14例，取得了良好的疗效，现将我们的点滴经验总结如下。     

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目的 探讨内镜下逆行胰胆管造影(ERCP)术后并发十二指肠穿孔的诊治方法。方法 对1996～2003年ERCP术后并发十二指肠穿孔的14例病人的诊治情况作回顾性分析，结果 8例行非手术治疗，其中5例痊愈；3例中转手术治疗，2例痊愈，1例死亡。另6例急诊手术，术式有穿孔修补、胆总管T管引流术、腹腔清创、腹腔引流、经胃窦十二指肠造瘘、空肠造瘘术，其中5例痊愈，1例死亡。结论 ERCP术后并发十二指肠穿孔具有特征性的临床表现及放射影像学征象，可作为决定手术与非手术治疗选择的重要指标，治疗方式必须根据各病例的特点选择。     

胃十二指肠溃疡穿孔非手术治疗的临床观察

目的探讨胃十二指肠溃疡穿孔(perforated gastroduodenal ulcer,PGDU)非手术治疗效果。方法回顾性分析2008年1月至2015年1月深圳市福田区人民医院PGDU病人186例,按拟定的适应证选择非手术综合治疗,按临床标准评估疗效,治疗达标后通过早期胃镜检查确定穿孔病因。结果本组186例PDGU病人中,全部经非手术治愈,无一例死亡。治疗期间接受胃镜检查177例(95.1%),确诊为胃十二指肠溃疡;未行胃镜检查确诊9例(4.9%)。餐后穿孔需腹腔穿刺引流的比例(71.8%)比空腹穿孔需要穿刺引流的比例(5.5%)高,差异有统计学意义(P0.05)。腹腔积液与无腹腔积液平均发热时间[(4.2±0.6)d比(2.2±0.5)d)]相比较,差异有统计学意义(P0.05);两者的平均住院时间[(8.2±0.8)d比(7.8±0.7)d)]相比较,差异无统计学意义(P0.05)。结论非手术治疗PDGU是安全有效的,期间如果有腹腔积液,可选择腹腔穿刺引流。     

Causes and treatment outcome of perforation peritonitis in north eastern Nigeria

Background: Intestinal perforations cause generalized peritonitis and overwhelming sepsis resulting in high morbidity and mortality. The purpose of the present study was to review the causes and treatment outcome of non-traumatic perforation peritonitis in a government referral hospital in north-eastern Nigeria. Patients and Methods: In a retrospective study, the clinical records of 153 patients with intraoperative diagnosis of non-traumatic perforation associated peritonitis managed in the Federal Medical Centre, Azare, Nigeria between June 2004 and May 2009 were reviewed. Results: One hundred and fifty-three patients, comprising 112 males (73.2%) and 41 females were operated for perforation peritonitis, including 31 (20.3%) children. The mean age was 21.88 years ± 14.51 (range 4–70). The mean time lapse between onset of symptoms and presentation to hospital was 5.4 ± 3.7 days (range 0.75–21). Forty-eight (31.4%) of the patients were operated within 24 h of presentation and 105 (68.3%) after 24 h. The main symptoms were abdominal pain in 150 (98.9%), fever in 108 (70.6%), and abdominal distention in 108 (70.6%). The main causes of perforation peritonitis were typhoid ileal perforation in 98 (64.0%), perforated peptic ulcer in 25 (16.3%) and perforated appendix in 22. Tuberculous ileal perforation was seen in one (0.6%) patient. Wound infection 39 (25.5%) and wound dehiscence 15 (9.8%), were the most common postoperative complications. Enterocutaneous fistula was seen in 21 (13.7%) of the patients and was associated with mortality in nine (42.8%) patients. The overall mortality rate was 26.1%, mainly from overwhelming sepsis and severe electrolyte derangement. Conclusion: The outcome of perforation peritonitis depended on the underlying cause, the duration of symptoms before treatment, and the general health of the patient. Typhoid ileal perforation is the most common cause of perforation peritonitis in our environment.     

Surgical treatment for right ventricular perforation caused by transvenous pacing electrodes: A report of three cases

We experienced three cases of right ventricular perforation that were induced by transvenous pacing electrodes. The patients were a 72-year-old man who underwent percutaneous transluminal coronary recanalization and angioplasty, an 80-year-old woman who had temporary transvenous pacing for a complete atrioventricular block induced by acute valvular heart failure, and a 44-year-old man who had received a permanent pacemaker. All three patients were treated surgically. The first and second patients demonstrated either cardiac tamponade or hemopericardium necessitating pericardial drainage. Spontaneous hemostasis did not occur in cases 1 and 2, due to either anticoagulant therapy or myocardial degeneration. Such patients require surgical closure of the perforation and pericardial drainage as soon as pericardial effusion is confirmed. In contrast, middle-aged individuals without myocardial damage, such as patient 3, need only a simple removal and repositioning of the electrode followed by serial echocardiography.     

腹腔镜在胃肠穿孔治疗中的应用(附23例报告)

目的：探讨腹腔镜下或腹腔镜辅助胃肠穿孔修补术的疗效。方法：对18例胃、十二指肠穿孔采用腹腔镜下全层缝合,加盖大网膜结扎固定;1例小肠穿孔在腹腔镜下双层缝合;3例小肠穿孔做腹壁小切口（2～3cm）,传统手术方法修补或切除病变肠管;1例乙状结肠穿孔行腹腔镜辅助下乙状结肠襻式造瘘。结果：18例胃、十二指肠穿孔及1例小肠穿孔在腹腔镜下完成修补术;3例小肠穿孔及1例乙状结肠穿孔在腹腔镜辅助下完成修复术。手术时间35～80min,平均50min。无并发症发生。23例随访6～24个月,平均18个月,18例胃、十二指肠穿孔术后6～8个月胃镜检查无溃疡复发,无肠梗阻等并发症发生。结论：腹腔镜治疗胃肠穿孔创伤小、恢复快、疗效满意。     

Duodenal perforation in a 14-year-old boy with abdominal tuberculosis despite being on antituberculous treatment

We are presenting a case of a 14-year-old male patient with known history of abdominal tuberculosis on medication for 4 months with frank peritonitis and air under the diaphragm found to have primary perforation of the duodenum due to tuberculosis. Tuberculosis is common in the third world but affects iliocaecal junction commonly. Cases with tuberculous duodenal are rarely reported in the literature.     

An unusual perforation of the colon: report of two cases

We herein present two cases of a colorectal perforation due to uncommon reasons. First, we treated a 45-year-old woman for a stercoral perforation of the sigmoid colon. The pathognomonic etiology was a barium fecaloma originating from an upper gastrointestinal series 9 months before admission. The second case was a 46-year-old woman who was admitted with a perforation of the transverse colon. She had experienced perforations of the sigmoid colon at 32 years of age and of the rectum at 44 years of age, respectively. The second and third conditions were diagnosed to be idiopathic, and were histologically proven by an abrupt obliteration and a thinness of the colonic wall with some infiltration of inflammatory cells. The first condition, however, was most likely a stercoral perforation. The postoperative course of these patients was uneventful, and both are doing well at this writing. Received: October 1, 2001 / Accepted: March 5, 2002     

儿童自发性胆道穿孔诊治经验

目的 探讨儿童自发性胆道穿孔(spontaneous perforation of the bile duct,SPBD)的临床特点、诊断及治疗.方法 回顾性分析首都医科大学附属北京儿童医院2007年6月至2020年8月收治的36例SPBD患儿的临床资料,评价腹部超声和腹腔穿刺的诊断价值,比较胆囊置管引流、穿孔部位置管...     

Esophagectomy for a traumatic esophageal perforation with delayed diagnosis

Esophageal perforations are rare, and traumatic perforations are even more infrequent. Due to the rarity of this condition and its nonspecific presentation, the diagnosis and treatment of this type of perforation are delayed in more than 50% of patients, which leads to a high mortality rate. An 18-year-old male patient was brought to the emergency room with a penetrating neck injury, caused by a gunshot wound. He was taken to the operating room and underwent surgical exploration of the neck and a chest tube was inserted to treat the hemo- and pneumothorax. During the procedure, a 2 cm lesion was detected in the esophagus, and the patient underwent a primary repair. A contrast leakage into his right hemithorax was noticed on the 4th postoperative day; he was submitted to new surgery, and a subtotal esophagectomy and jejunostomy were performed. He was discharged from the hospital in good condition 20 d after the last procedure. The discussion around this topic focuses on the importance of the timing of diagnosis and the subsequent treatment. In early diagnosed patients, more conservative therapeutics should be performed, such as primary repair, while in those with delayed diagnosis, the patient should be submitted to more aggressive and definitive treatment.     

腹腔镜治疗胃十二指肠溃疡穿孔26例报告

目的:探讨腹腔镜胃十二指肠溃疡穿孔修补术的应用价值。方法:回顾分析2004年3月至2008年11月我院为26例胃十二指肠溃疡穿孔患者行腹腔镜穿孔修补术的临床资料。结果:25例成功完成腹腔镜手术,1例中转开腹。手术时间75～100min,平均(79.2±18.3)min,术后住院5～9d,平均6.8d,无术后并发症及死亡病例。结论:腹腔镜治疗胃十二指肠溃疡穿孔具有患者创伤小,康复快,并发症少,住院时间短等优点,值得在临床工作中推广应用。