儿童外伤所致单纯性十二指肠壁内血肿的诊治经验

目的探讨外伤所致儿童单纯性十二指肠壁内血肿的临床病程、诊断及治疗经验。方法回顾性分析本院近10年来收治的8例外伤所致单纯性十二指肠壁内血肿患儿临床资料,年龄6~12岁,均有腹部外伤史,临床主要表现为腹部隐痛,渐进性胆汁性呕吐。分析其壁内血肿形成的可能机制、诊断及治疗方案。结果术前上消化道造影均显示十二指肠降段或水平段部分或完全性梗阻;上腹部增强CT显示十二指肠壁内血肿。2例经保守治疗痊愈,6例经手术治疗后痊愈。结论单纯性十二指肠壁内血肿起病较隐匿,根据上腹部外伤史、渐进性胆汁性呕吐及影像学检查多可明确诊断。建议首选保守治疗,若保守治疗3周无效可行手术探查,必要时行十二指肠近端与空肠旁路手术。     

小儿外伤性十二指肠壁内血肿的诊断和治疗

目的小儿外伤性十二指肠壁内血肿临床少见，本文探讨其诊断和治疗特点。方法回顾总结本院收治的6例外伤性十二指肠壁内血肿患儿病例资料，并行文献复习。结果本组患儿均有明确的腹部外伤史，主诉右上腹疼痛，胆汁性呕吐，查体右上腹压痛，B超或CT证实为十二指肠壁内血肿，所有病例均行保守治疗，其中1例剖腹探查明确诊断后继续保守治疗，5～14d症状好转，痊愈出院。结论腹部外伤史，右上腹疼痛，上消化道梗阻症状，结合B超、CT所见，可明确诊断小儿外伤性十二指肠壁内血肿。该损伤大多可用非手术方法治愈。     

婴幼儿及儿童外伤性硬膜外血肿治疗决策

目的 探寻婴幼儿及儿童外伤性硬膜外血肿的最佳治疗方法.方法 对43例婴幼儿及儿童外伤性硬膜外血肿采取保守治疗17例、钻孔引流血肿溶解治疗23例、开颅血肿清除治疗3例,评价疗效.结果 随访1年,格拉斯哥预后评分1分1例,3分2例,4分5例,5分35例.结论 婴幼儿及儿童外伤性硬膜外血肿有手术指征者应尽早手术,手术方式最好选择钻孔引流血肿溶解术,简便易行,是治疗婴幼儿及儿童硬膜外血肿的有效方法之一.     

小儿外伤性十二指肠壁血肿2例报告

小儿外伤性十二指肠壁血肿所致十二指肠梗阻比较少见,我院收治2例,现报道如下。例1 女,5岁。脐周阵发性腹痛,频繁呕吐胆汁5天入院。体检:急性病容,皮肤弹性差,脐周有压痛,未触及肿块。血Hb89g/L,WBC10×10~9/L,     

儿童急性硬膜外血肿的特点及治疗

本文报告 2 3例儿童急性硬膜外血肿 (ＥＤＨ) ,头颅ＣＴ扫描确诊 2 0例 ,急诊开颅 3例。入院时ＧＣＳ <8分 2例 ,8～ 12分 10例 ,13～ 15分 11例。ＣＴ提示中线结构移位 >1.0ｃｍ者 9例。幕上血肿 2 2例 ,均为一侧单发性血肿 ,后颅凹 1例。脑挫裂伤 6例 ,头痛 10例 ,呕吐 5例 ,短暂意识障碍 15例 ,有明显中间清醒期 3例 ,无明显症状 13例。双侧瞳孔不等大 3例 ,偏瘫 2例。手术治疗 15例 ,保守治疗 8例 ,2例康复出院 ,1例并广泛脑挫伤死于肺部感染。故急性外伤性ＥＤＨ一旦确诊 ,应立即手术 ,但某些ＥＤＨ可采取保守治疗 ,认为必须根据血肿的…     

新生儿十二指肠梗阻腹腔镜手术围术期并发症探讨

目的：探讨新生儿十二指肠梗阻腹腔镜手术围术期并发症的特点,并分析其产生原因和应对方法。方法总结分析本中心2012年1月至2016年5月经腹腔镜手术治疗的81例先天性十二指肠梗阻患儿临床资料。男性48例,女性33例;其中早产儿45例（孕周32～37 w）;低体重儿30例（体重＜2500 g,最小体重1304 g）。包括肠旋转不良35例,环状胰腺24例,十二指肠隔膜11例,十二指肠闭锁5例,多发畸形6例（环状胰腺伴隔膜1例,环状胰腺伴旋转不良4例,2处隔膜1例）。结果全组患儿除2例肠旋转不良中转开腹手术外,其余79例均完成腹腔镜手术;环状胰腺术后吻合口漏1例,经禁食、胃肠减压和支持治疗2周后痊愈;肠旋转不良手术后肠扭转、肠坏死1例,予再次开腹手术;旋转不良结肠电灼伤穿孔1例,予再次开腹手术修补;环状胰腺术后戳孔大网膜疝出1例,予再手术回纳。结论腹腔镜手术治疗新生儿十二指肠梗阻虽然较开放手术有优势,但同时也要注意其相关并发症。注意防范,不断提高手术技能,注重细节,扬长避短,尽可能减少并发症的发生。     

手术治疗小儿肠系膜上动脉压迫综合征12例

目的对小儿肠系膜上动脉压迫综合征(superior mesenteric artery syndrome,SMAS)的临床诊断和术式选择进行评价。方法总结2000年8月至2015年1月经作者手术治疗的12例SMAS患儿临床资料,并结合文献就其病因、诊断及手术方式进行分析。结果本组12例均行上消化道造影检查,都显示钡剂通过十二指肠水平段受阻,表现为典型的纵行"笔杆征"压迹,3例钡剂在胃和十二指肠内形成明显的反复交流的"钟摆样"运动。所有患儿均经保守治疗无效而行手术治疗,其中十二指肠空肠侧侧吻合术4例,十二指肠空肠侧侧吻合加Treitz韧带松解术2例,Ladd手术4例,肠系膜上血管前十二指肠空肠吻合术2例,均痊愈出院,无并发症发生。随访6个月至10年,3例早期复发,经保守治疗痊愈。结论上消化道钡剂造影是SMAS主要的确诊手段。本病保守治疗无效需手术治疗,其手术方式多样,可根据不同病理类型选择相应术式,凡能解除机械性梗阻而无明显弊端的术式均可采用,十二指肠空肠侧侧吻合术及Ladd手术值得推荐。     

儿童硬膜外血肿31例

目的 探讨儿童破硬外血肿合理的治疗方法。方法 对31例儿童硬膜外血肿分别采用保守治疗、钻孔引流及开颅血肿清除，观察疗效。结果 保守治疗14例恢复良好；钻孔引流9例，1例轻残；开颅血肿清除8例，3例轻残，1例死亡。结论 儿童硬膜外血肿尽量保守治疗，必须手术者是最好选择钻孔引流。     

先天性十二指肠梗阻的诊断与治疗探讨

目的探讨十二指肠梗阻的病理特点及临床诊断与治疗方法.方法回顾性分析本院近10年来收治的47例十二指肠梗阻患儿临床资料.包括先天性肠旋转不良26例,十二指肠闭锁狭窄15例,环状胰腺4例,肠系膜上动脉综合征2例.患儿均予手术治疗,其中行Ladd手术31例次,十二指肠菱形吻合手术9例,隔膜切除十二指肠成型手术10例,十二指肠空肠吻合手术1例.结果 47例中,42例存活,3例死亡,2例放弃治疗,自动出院.结论先天性十二指肠梗阻的主要病因为先天性肠旋转不良、十二指肠闭锁狭窄、环状胰腺,部分病例存在两种病因;一旦确诊应尽早选择合理的手术方法进行治疗,术后应注意预防并发症.     

小儿外伤性胰十二指肠损伤5例临床诊治

目的探讨小儿外伤性胰十二指肠损伤的早期诊断和治疗方法。方法回顾性分析1988年10月～2003年10月我院5例小儿外伤性胰十二指肠损伤的临床资料。结果5例均有外伤后上腹部疼痛,3例有肌紧张,2例经腹腔穿刺见暗红色液体,腹水淀粉酶升高,2例腹部B超检查见液性暗区,1例腹部平片检查见隔下游离气体,1例见右肾周气影,5例均急诊剖腹探查,术中证实4例十二指肠破裂,1例胰尾部断裂,经仔细地修补、有效的十二指肠减压及审慎地处理胰腺损伤和引流,均痊愈出院。结论早期手术探查及合适的术式是治愈的关健。     

Stricture of the duodenum and jejunum in an abused child

We report a case of abdominal injury secondary to child abuse in which the child had both a duodenal hematoma and contained perforations of the duodenum and proximal jejunum. These injuries were evaluated by both CT scan and upper gastrointestinal (GI) series. The child's nausea and vomiting persisted despite conservative treatment; after 3 weeks a repeat upper GI series demonstrated high-grade duodenal obstruction. An exploratory laparotomy was performed and a calcified, fibrotic mesentery and strictures in the distal duodenum and proximal jejunum were found. To our knowledge, this unusual complication of blunt abdominal trauma has not been described in association with child abuse. Received: 31 May 1996 Accepted: 16 September 1996     

Radiological evaluation of visceral injuries in the battered child syndrome

Diagnostic imaging plays an important role in the recognition, evaluation, and follow-up of visceral injuries in the battered child syndrome. Conventional radiography is important for the diagnosis of associated skeletal fractures, pulmonary parenchymal injury, gastric dilatation, and pneumoperitoneum. An upper gastrointestinal series is the examination of choice in suspected intramural duodenal hematoma. Ultrasonography is helpful in the diagnosis of retroperitoneal hematoma, acute traumatic pancreatitis, and pancreatic pseudocyst. Nuclear scintigraphy is valuable if injury is limited to the liver or spleen. CT is the imaging modality of choice for assessing generalized blunt abdominal trauma as well as evaluating the extent of injuries to the liver, spleen, pancreas, kidneys, and mesentery.     

Operative and postoperative management of congenital duodenal obstruction: a 10-year experience

Forty-five patients with congenital duodenal obstruction aged from 1 day to 11 months were operated upon during the last decade. Group A included 25 neonates with duodenal obstruction due to atresia type I or a complete diaphragm in 10 cases, atresia type II in 3, atresia type III in 1, stenosis or incomplete diaphragm in 4, annular pancreas in 6, and aberrant vessels in 1. Seven duodenoduodenostomies (D-D) were performed, 14 duodenoplasties (D-P) with occasional excision of the diaphragm, and 4 duodenojejunostomies (D-J). Tapering, plication of the proximal duodenum, or gastrostomy was not performed in any child and no transanastomotic tube was placed. Group B included 20 infants with duodenal obstruction due to peritoneal bands and associated malrotation. They all underwent Ladd's procedure. All children in group B and 15 in group A had an uneventful recovery and tolerated oral feedings within the first 10 days postoperatively without any complication. Six children in group A had prolonged postoperative ileus and were treated with total parenteral nutrition (TPN), gastric decompression, and radiologic evaluation of anastomotic patency. These 6 children eventually tolerated oral feeding between the 18th and 45th postoperative days. In 1 child a technical error was found that caused a prolonged ileus. Three children died within the 1st postoperative week. It is concluded that simple establishment of continuity of the gastrointestinal tract by performing the appropriate surgical procedure in combination with TPN and gastric decompression gives satisfactory results in the management of duodenal obstruction.Presented at the 15th Annual International Meeting arranged by the Greek Association of Pediatric Surgeons.     

小儿术后早期炎症性肠梗阻的诊断及治疗

目的探讨小儿术后早期炎症性肠梗阻的诊断及治疗方法。方法对2000年1月至2008年12月收治的50例术后早期炎症性肠梗阻患儿的临床资料进行回顾性分析。结果48例经胃肠减压、生长抑素、维持内环境稳定、完全胃肠外营养以及肾上腺皮质激素等保守疗法治愈。结论小儿术后早期炎症性肠梗阻多发生于术后4～7d,可表现为典型的肠梗阻体征,但有其特征性。主要症状为腹胀、肛门停止排气排便,而腹痛较轻,多由小肠无菌性炎症导致广泛或局部肠粘连引起,多数采用保守疗法治愈。     

小儿外伤性十二指肠血肿并肠梗阻13例

目的：探讨腹部闭合性损伤小儿中十二指肠血肿并肠梗阻的诊断策略和治疗原则。方法回顾性分析本院2006年1月至2013年3月收治的13例腹部闭合性损伤致十二指肠血肿并肠梗阻患儿的临床资料。年龄4～12岁,其中男性9例,女性4例。血肿长径6．0～11．0cm,其中8例术前已明确诊断,5例经术中探查确诊。手术时受伤时间2～6d。患儿均行剖腹探查加十二指肠浆膜下及腹膜后血肿清除术,术后均留置引流管。其中3例同时行近端空肠造瘘术。术后定期复查。结果13例均顺利完成手术。术后2例出现伤口感染,无其他严重并发症,均顺利恢复。经半年以上复查随访未见异常。结论详细的病史采集结合X线、B超和CT等辅助检查对于小儿腹部闭合性损伤致十二指肠血肿并肠梗阻的早期诊断至关重要。积极手术探查有利于明确诊断并给予及时处理,术后严重并发症少,治疗效果满意。     

Appendicitis after blunt abdominal trauma in the pediatric patient — fact or fancy?

At the Hospital for Sick Children, Toronto, about 300 children a year are operated on with the diagnosis of acute appendicitis. In four such cases in the last 15 years blunt abdominal trauma preceded the acute appendicitis. The four children (three boys and one girl) ranged from 6 to 15 years. Within 7 days of the blunt abdominal trauma the patients developed signs and symptoms of peritonitis requiring laparotomy. They all had an appendectomy for acute appendicitis; one boy also had 150 ml of old blood from a splenic hematoma. Although any child who has suffered blunt abdominal trauma and then slowly develops peritoneal signs in the lower abdomen may be suspected of having acute appendicitis, it seems reasonable to assume that this sequence of events is more coincidence than real.     

Management of pancreatic and duodenal injuries in pediatric patients

Diagnosis of duodenal and pancreatic injuries is frequently delayed, and optimal treatment is often controversial. Fourteen children with duodenal and/or pancreatic injuries secondary to blunt trauma were treated between 1980 and 1997. The pancreas was injured in all but 1 child. An associated duodenal injury was present in 4. The preoperative diagnosis was suspected in only 6 patients based on clinical signs and ultrasonography. One patient was treated successfully conservatively; all the others required surgical management. At operation, three procedures were used: peripancreatic drainage, suture of the gland or duodenum with drainage, and primary distal pancreatic resection without splenectomy. A duodenal resection with reconstruction by duodeno-duodenostomy was performed in 1 case. The overall complication rate was 14%: 1 fistula and 1 pseudocyst. Pancreatic ductal transection was recognized 3 days after the initial laparotomy by endoscopic retrograde cholangiopancreatography (ERCP). The mortality was 7%; 1 patient died from septic and neurologic complications. When the diagnosis of pancreatic ductal injuries is a major problem, ERCP may be a useful diagnostic procedure. Pancreatic injuries without a transected duct may often be treated conservatively. The surgical or conservative management of duodenal hematomas is still controversial; other duodenal injuries often need surgical treatment. Accepted: 26 April 1999     

Pediatric abdominal trauma: evaluation by computed tomography

When indications for immediate laparotomy are not present, CT of the abdomen and pelvis can be used to evaluate pediatric blunt abdominal trauma. During 2-year period, the medical records and abdominal/pelvic CT scans of 100 consecutive pediatric patients who were evaluated for blunt abdominal trauma were retrospectively reviewed. The scans appeared normal for 73 children. Of these children, 30 had severe head injuries and a depressed sensorium. A total of 27 abdominal/pelvic CT scans were interpreted as abnormal. Findings included nine splenic fractures, six renal contusions, nine hepatic lacerations, one duodenal hematoma, one traumatic pancreatitis, four bony injuries, six miscellaneous abnormalities, and one intraperitoneal bleed. Only two of these 27 patients required abdominal surgery. The remaining 25 patients were treated conservatively based upon a stable clinical state and CT delineation of the extent of injury. No mortality resulted. CT is the radiographic examination of choice for hemodynamically stable pediatric patients with blunt abdominal trauma. CT provided a reliable adjunct examination technique when a physical examination could not be performed and a complete history could not be obtained. The extent of abdominal/pelvic injuries is well delineated and can often be followed by diagnostic imaging, usually allowing for conservative therapy.     

腹腔镜一期手术治疗小儿阑尾周围脓肿

目的探讨经腹腔镜一期手术治疗小儿阑尾周围脓肿的可行性及临床疗效。方法2010年11月至2012年11月我们收治17例阑尾周围脓肿患儿,男10例,女7例,年龄（6．78±3．46）岁,病程：（3—11）d,平均5．12d;影像学检查显示右下腹包块,均经腹腔镜探查证实为阑尾周围脓肿,子阑尾切除、腹腔引流术。结果患儿均手术顺利,术后均获随访,随访时间1个月至1年,手术时间（98．53±35．41）min,住院时间（12．12±6．35）d,术后出现切口感染2例（占11．2％）,肠梗阻1例,腹腔残余脓肿1例,经保守对症治疗均获治愈,元严重并发症。结论腹腔镜一期治疗阑尾周围脓肿安全显效。