双气囊小肠镜在儿科临床应用价值

目的评估双气囊小肠镜在儿科中的临床应用价值。方法回顾分析2016年7月—2019年4月行双气囊小肠镜检查的患儿临床资料。结果 44例患儿,男31例、女13例,平均年龄(9.64±3.36)岁(2岁9个月～15岁),平均体质量(34.91±15.10)kg(12.6～65 kg);不明原因消化道出血25例、腹痛16例、腹泻2例、P-J综合征1例。25例患儿检出病变,其中年龄6岁的7例患儿中4例检出病变。25例消化道出血患儿中16例检出病变,16例腹痛患儿中8例检出病变,2例腹泻患儿中1例检测病变。检出病变包括回肠憩室14例、克罗恩病4例、小肠非特异炎症(充血、糜烂、溃疡)3例。所有患儿在双气囊小肠镜检查后均未出现穿孔、严重出血及麻醉等并发症。结论双气囊小肠镜在儿童小肠疾病诊断中有重要作用,且安全。     

小肠镜检查技术在儿童小肠病变中的诊断及治疗价值

小肠镜在成人小肠疾病中有很高的诊断和治疗价值,是一种安全有效的检查和治疗手段。但小肠镜在儿童中应用较少,目前小肠镜被用于儿童不明原因消化道出血、小肠息肉、克罗恩病、小肠狭窄、胆道狭窄等的诊断和治疗,该文介绍了小肠镜检查技术在儿童小肠疾病中的临床应用。     

双气囊小肠镜在儿科患者中的应用

目的 探讨双气囊小肠镜在儿童中的使用方法、安全性,评价其临床价值,及其在儿科应用的困难.方法 本组22例,为2006年12月至2009年10月在我院消化科住院,因为胃肠道出血、再发性腹痛、低蛋白血症等原因接受双气囊小肠镜检查患儿,年龄4～16岁,所有操作均在麻醉下进行,患儿均取仰卧位,利用双气囊小肠独有的外套管、肠镜前端的双气囊交替充气、放气,经幽门或回盲瓣进入小肠,小肠镜和外套管不断地前进和退镜,将小肠缩短到内窥镜可以检查的范围.在检查过程中记录检查范围、病变,患儿耐受性等.结果 本组共接受25例次双气囊小肠镜检查,其中3例次顺行进镜,22例次逆行进镜;3例同时经口和经肛门检查.18例发现病灶,病变检出率为81.82%.所有操作均在麻醉下进行,包括麻醉和术后恢复,一般需要90～120 min.本组均未发生吸入性肺炎、肠道穿孔、出血等严重并发症.通过双气囊小肠镜,诊断克罗恩病7例,Meckel憩室并溃疡3例,空肠、横结肠息肉1例,小肠淋巴管扩张症1例、阿米巴肠炎1例、小肠炎出血3例,非特异性回肠炎2例.本组均耐受检查,未发现严重不良反应和并发症.结论 双气囊小肠镜对小肠疾病有良好的检出率,儿童患者能耐受检查,在儿科患者中应用是有效和可行的.但双气囊小肠镜在儿科的推广应用仍受到一些因素的制约.     

单气囊小肠镜在小肠出血患儿中的临床应用

目的：探讨单气囊电子小肠镜在小肠出血患儿中的诊断价值和安全性。方法：临床怀疑小肠出血患儿共70例,其中男 38 例,女 32 例,年龄 4～13 岁;均在全麻下行单气囊小肠镜检查,其中经口途径检查 26例,经肛门途径检查 32 例,同时经口和肛门检查12例。结果：70例患儿中检查出小肠病变58例,检查阳性率 83％,其中非特异性炎症 24例,过敏性紫癜 12 例,克隆病 8 例,美克尔憩室 8 例,Peutz-Jeghers综合征 6 例。结论：单气囊小肠镜检查是诊断小肠出血患儿一项较为安全、有效的检查手段。     

推进式双气囊电子小肠镜对儿童小肠疾病诊断的研究

目的评价双气囊电子小肠镜在儿童中应用的安全性、检查范围、临床价值。方法2003年6月—2005年5月,对14例年龄在3～14岁,经多项常规检查阴性,怀疑为小肠疾病的患儿行双气囊电子小肠镜检查。其中13例为原因不明的消化道出血、缺铁性贫血,1例为慢性腹泻。结果双气囊电子小肠镜抵达空、回肠交界部2例,回肠中下端10例和末端回肠2例,检查所用时间分别为,空、回肠交界部40～50min,回肠中下端55～70min和末端回肠78～89min。14例受检患儿中,12例发现病灶,阳性检出率为85．7％。未见操作相关的严重不良反应和并发症。结论双气囊电子小肠是诊断小肠疾病较好的检查手段,在儿童中应用是安全、可行的。     

儿童小肠镜临床应用管理专家共识

小肠疾病是消化系统疾病诊治难点之一,检查技术有限,严重制约了儿童消化道疾病的诊疗水平。随着小肠镜在儿科临床应用的推广与小肠镜设备和附件的优化,小肠镜技术为儿科消化道诊疗提供了新的手段,但临床操作规范化和镜下治疗面临诸多问题和挑战。为规范儿童小肠镜诊疗技术及提高小肠疾病的诊疗水平,中华医学会儿科学分会消化学组牵头,组织专家充分讨论,并参考儿童小肠镜临床应用的最新进展,制定了儿童小肠镜临床应用管理专家共识。     

胃镜代替肠镜技术在小儿结肠镜检查中的应用

目的：探讨用胃镜代替结肠镜的方法对小儿进行结肠镜检的效果。方法：对需进行结肠镜检的小儿患者,采用随机对照的方法进行分组,分别采用成人型胃镜和成人型肠镜进行全结肠检查。结果：两种方法插镜进入回盲部的成功率没有差别(P>0.05), 但到达回盲部的平均时间有差别(P<0.05), 胃镜检查并发症的发生率更低(P<0.01)。结论：成人型胃镜代替成人型肠镜进行小儿结肠镜检查安全可靠,具有一定优势, 有进一步研究和应用的价值。     

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。     

纤维内镜在小儿消化道疾病中的临床应用

消化道疾病，临床表现多样.症状多不典型，常被误诊或负诊[1]。10年内我们对有呕吐、腹痛、呕血、黑便等消化道症状的62例14岁以下儿童进行了消化道纤维内镜检查，检出阳性病例32例，现报告如下。材料、方法与结果一、一级资料病人为1986年1月～1995年12月儿科就诊的14岁以下有     

单气囊小肠镜用于诊治儿童黑斑息肉综合征的临床价值研究(附7例报告)

目的探讨单气囊小肠镜(SBE)对儿童黑斑息肉综合征(PJS)患者小肠息肉治疗和随访的应用价值。方法 2009年5月至2012年11月湖南省儿童医院收治应用SBE对临床证实或怀疑为PJS的7例患者进行检查和治疗,主要观察指标包括SBE检查治疗完成情况、小肠息肉切除成功率和切除数量、操作时间和并发症等。结果共对7例患者进行了18次检查(男4例,女3例,年龄范围4.4~14岁,经口检查9次,肛门9次),平均检查时间120 min(95~180 min),6例患儿有小肠多发息肉,在小肠镜下行了散发息肉的切除,共切除小肠散发息肉16颗。本组SBE镜下治疗小肠息肉的病例无肠穿孔、肠梗阻、大出血等严重并发症发生。结论 SBE为儿童PJS患者提供了一种新的监控和治疗小肠息肉的安全有效的方法。     

Cajal间质细胞与儿童胃肠道炎性反应的关系

Cajal间质细胞(ICCs)的主要功能是产生胃肠道慢波电位,同时推进电活动的传播及参与神经信号的传递。胃肠道ICCs减少或分布异常易造成胃肠道炎性反应的发生,但另一方面,胃肠道发生炎性反应时,炎性细胞及炎性反应介质也可引起ICCs数量的减少。     

Double balloon enteroscopy for pediatric inflammatory bowel disease

Background: The aim of the present study was to evaluate the efficacy and safety of double balloon enteroscopy (DBE) in children with inflammatory bowel disease (IBD). Methods: A total of 106 DBE procedures in 67 patients were performed at Mie University Hospital from January 2008 to June 2011. Of these, 17 procedures in 12 children and adolescents with established or suspected Crohn's disease (CD) were included in the present study. The procedure, sedation, efficacy, and safety of DBE were evaluated. Results: Mean patient age was 12.9 years (range, 3–19 years). Patients ≤15 years old had general anesthesia. The procedures included the oral approach (n= 9), the anal approach (n= 4), and the ileostomal approach (n= 4). The mean procedure duration was 60 min. Accurate diagnosis was obtained in 7/8 cases (88%) of suspected CD. Only one case was diagnosed as indeterminate colitis, although the total small and large bowel was examined on DBE and pathology. Procedure tolerance was acceptable and recovery was uneventful in all cases. No serious complications were encountered. Conclusions: With regard to the present limited IBD pediatric case series, DBE is a safe and effective procedure.     

Inoue球囊瓣膜成形术治疗儿童先天性肺动脉瓣狭窄22例

目的探讨先天性肺动脉瓣狭窄病例经皮穿刺Inoue球囊肺动脉瓣成形术的体会。方法患儿22例。男10例,女12例。年龄9.5~14.0(11.2±2.6)岁,先行右室造影及右心导管检查,测量压力及肺动脉瓣环直径,应用Inoue环形导丝建立钢丝轨道,使导丝前端在肺动脉形成自然圆圈状以固定轨道钢丝。选用最大径较肺动脉瓣环直径大20%~40%Inoue球囊进行扩张。结果本组22例均扩张成功。5例术后出现反应性右室流出道狭窄,经药物治疗后好转。1例出现三尖瓣乳头肌断裂,经外科治疗痊愈。结论对于较大儿童应用Inoue球囊进行肺动脉瓣成形术治疗效果良好,但应严格掌握操作程序。     

Gastrointestinal tract ulcers in pediatric intestinal transplantation patients: etiology and management

One of the observed complications in patients after intestinal transplantation is the occurrence of ulcers in the native or transplanted gastrointestinal tract. Previous reports have described the appearance of ulcers but have not described any systemic approach to accurately diagnose the etiology of the ulcer. We evaluated 112 intestinal transplantation patients at our institution, in which endoscopic examination identified ulcer formation in 11 patients. No common or defining demographic or clinical variables were found in the patients with ulcers. Biopsies were obtained from the ulcer edge as well as the intervening mucosa. The most common changes in the ulcers were compatible with post-transplant lymphoproliferative disorder (PTLD), acute rejection, and viral infections. These changes could occur simultaneously and retrospective analysis showed that ulcers could have concomitant etiologies. Endoscopically directed biopsies of ulcer edges often displayed morphologic changes compatible with acute rejection of the graft. Some patients were treated for rejection based on the changes within the mucosa outside the ulcer bed, and they responded with resolution of the ulcers. Our findings demonstrate that PTLD and acute rejection are the most common causes of chronic ulcer formation and reinforce the concept that biopsy samples should be collected simultaneously from both the ulcer edge and intervening mucosa.     

经皮球囊肺动脉瓣成形术治疗小儿肺动脉狭窄的疗效

目的观察经皮球囊肺动脉瓣成形术(PBPV)治疗肺动脉瓣狭窄(PS)患儿的术后疗效及安全性。方法对本院2005-2008年采用PBPV治疗的PS患儿54例进行分析。首选右心导管分别测量患儿右心房、右心室及肺动脉压力,然后单球囊法扩张其肺动脉瓣,术后采用超声心动图评价疗效。结果右室收缩压:PS患儿术前(65.30±25.40)mmHg(1 mmHg=0.133 kPa),术后(34.20±10.08)mmHg;跨肺动脉瓣压力阶差(PG):PS患儿术前(50.30±20.01)mmHg,术后1 d(19.96±6.95)mmHg,术后1个月(19.40±6.87)mmHg;术后1 d PG<20 mmHg达89.7%,术后1个月PG<20 mmHg达92.1%。PS患儿均未观察到并发症发生,术中失血量少,无输血,术后生命体征平稳。术后1个月经超声心动图随访无再狭窄发生。术后心脏杂音减轻,震颤全部消失,心电图大部分正常。结论PBPV治疗PS是安全有效。病例选择、精确测定肺动脉瓣直径和选择大小合适的球囊是手术成功的重要环节。     

Normal Length of the Human Fetal Gastrointestinal Tract

Little information is available on the normal length of the gastrointestinal tract in fetuses or on factors that may affect its growth. To determine normal growth patterns of the fetal intestine, 58 fetuses received in the Central Laboratory for Human Embryology between January 1, 1987, and July 1, 1988, in which no abnormalities were noted on autopsy, were studied. The gastrointestinal tract was removed from the fetus en bloc from the esophagogastric junction to the pelvic floor and dissected. Measurements of stomach, small and large intestines, and appendix length were made and correlated with gestational age as determined by footlength. Overall growth of the gastrointestinal tract as well as that of each component was linear with respect to gestational age. In addition, five fetuses with omphalocele, 16 with cardiac malformations, and 20 with chromosomal abnormalities were studied. The total lengths of the gastrointestinal tracts in the first group were below the normal range in four of five fetuses. Those with cardiac defects had intestinal lengths below the mean, but the measurements were abnormal in only three. In both groups those fetuses with chromosomal abnormalities appeared to have shorter intestinal tracts than those with normal or unknown karyotypes. The gastrointestinal tracts of aneuploid fetuses fell within the normal range until approximately 20 weeks gestation, after which growth decreased. This growth failure may reflect the growth retardation seen in fetuses with chromosomal abnormalities.     

Disseminated Neonatal Gastrointestinal Mucormycosis: A Case Report and Review of the Literature

Mucormycosis of the gastrointestinal tract is a rare and fatal infection of neonates and children. This report describes a case of disseminated mucormycosis originating in the gastrointestinal tract of a premature infant of 26 weeks gestational age. The antemortem impression was that of necrotizing enterocolitis, diagnosed at 15 days of age, followed by death at 22 days. However, autopsy revealed extensive colonization and invasion of the small intestine and colon by mucormycosis, with blood and peritoneal fluid cultures positive for Mucorales species but negative for bacteria. There was associated hematogenous and adjacent spread of organisms to other viscera.     

幽门螺杆菌相关性慢性胃炎患儿胃肠激素的变化

目的探讨幽门螺杆菌(Hp)相关性胃炎患儿血促胃液素(GAS)、胃动素(MTL)、生长抑素(SS)分泌的变化。方法观察组50例慢性胃炎患儿,其中Hp阳性21例,Hp阴性29例;对照组30例为体检健康患儿。检查两组儿童空腹血GAS、MTL、SS水平,均采用放射免疫法进行测定,并对50例观察组患儿行胃镜检查,取胃窦黏膜2块及十二指肠球部黏膜1块作病理组织Giemsa染色。结果1.Hp阳性组血GAS含量(173±46)ng/L,明显高于Hp阴性组(110±20)ng/L,t=3.274 P<0.01,有显著性差异。2.Hp阳性组血MTL含量(187±53)ng/L,Hp阴性组(212±69)ng/L,两组比较无明显差异(t=2.494 P>0.05)。3.Hp阳性组血SS含量(144.5±11.0)ng/L,明显低于Hp阴性组(187.4±26.0)ng/L(t=3.897 P<0.01)。结论Hp阳性患儿血中存在GAS、SS的异常分泌,其分泌水平的异常为慢性胃炎的发病机制、诊断和治疗提供重要依据。