多脏器功能障碍成功抢救1例

患儿,男,6个月,因发热2d ,腹泻1d ,腹胀3h伴呕吐入院。入院后腹胀明显且进行性增大。急诊探查术,发现回回结肠型肠套,小肠穿孔。术中血压下降至5 0 / 30mmHg ,SaO2 下降30 %左右。术后转PICU进一步治疗。辅助检查:弥散性血管内凝血(DIC)指标凝血酶原时间2 0 .8s,部分凝血活酶时     

基于"肛肠平衡"原则治疗先天性巨结肠患儿术后肠功能不良的研究

目的分析基于"肛肠平衡"原则治疗先天性巨结肠(Hirschsprung disease, HD)患儿术后肠功能不良的临床疗效。方法收集2019年7月至2021年7月在华中科技大学同济医学院附属同济医院小儿外科由单一治疗组收治的30例HD术后肠功能不良患儿的相关资料。其中, 男19例, 女11例, 平均年龄为2.4岁;临床症状包括腹胀21例, 便秘28例和肠炎23例。患儿既往治疗HD的手术方式为结肠次全切除术(25例)和全结肠切除术(5例)。所有患儿先进行肛门内括约肌肉毒杆菌毒素注射术(2 U/kg);3～6个月后对仍出现症状的患儿再次施行注射术;对接受肉毒杆菌毒素注射术≥2次, 但反复出现肠功能不良的患儿施行肛门内括约肌肌条切除术。术后常规进行直肠肛管测压检查, 并记录患儿腹胀、排便情况。结果所有患儿接受肉毒杆菌毒素注射术后, 排便次数较术前增加, (1.1±0.6)次比(5.4±1.1)次;肛门静息压较术前降低, (62.1±9.1)mmHg比(27.3±5.4)mmHg (1 mmHg=0.133 kPa);便秘、腹胀、肠炎症状较术前改善, 差异均具有统计学意义(P<0.01...     

先天性梅毒并胎粪性腹膜炎及败血症1例

患儿男 ,9天。因腹胀 7天 ,皮疹伴拒乳1天于 2 0 0 2年 3月 7日入院。患儿系第 1胎第 1产 ,孕 41周顺产。患儿腹胀逐渐加重 ,热敷无缓解 ,精神、食欲欠佳 ,已排胎粪 ,无发热、恶心、呕吐及腹泻。体检 :Ｔ36 .5℃ ,Ｐ12 2 /ｍｉｎ ,Ｒ46 /ｍｉｎ ,体重 2 .2ｋｇ ,呼吸表浅 ,面色     

肠旋转不良术后并坏死性小肠结肠炎致肠狭窄1例

患儿 ,男 ,4ｄ ,足月顺产 ,生后 2ｄ出现呕吐 ,为黄绿色胃内容物 ,次日排果酱样血便 3次。查体 :腹胀 ,无压痛 ,无包块 ,肠鸣音弱。腹立位平片 :生理性积气减少且不规则 ,可见液平。钡灌肠见回盲部位于右上腹。手术见肠旋转不良 ,小肠顺时针扭转 450度 ,空肠有 1 0ｃｍ呈暗红色 ,给予温盐水热敷及0 .1 %普鲁卡因封闭肠系膜后肠管血运及蠕动恢复。行Ｌａｄｄ术 ,术后 3ｄ开始哺乳出现腹泻、腹胀、反应差、体温升高。大便常规 :ＷＢＣ :0～ 1 /ＨＰ ,ＲＢＣ :0～ 1 /ＨＰ。疑并发坏死性小肠结肠炎 (ＮＥＣ) ,立即禁食 ,保守治疗 1周痊愈。术后…     

先天性无肛合并胃穿孔食道闭锁气管瘘一例

患儿,男,2天,自出生后即开始腹胀,渐加重,精神差、拒乳,无呕吐,伴发热体温29℃,后发现患儿无肛门,门诊以“先天性无肛门”收住院。体检:体温40℃,精神差,心肺未见异常,腹高度膨胀,可见腹部静脉显露,腹壁红肿,未见胃肠型,肠鸣音弱,会阴部无肛门开口。腹部倒立位平片:直肠盲端距肛门皮肤约1.6cm,诊断:先天性中位无肛。行会阴肛门成形术,拖出直肠,有少量胎粪排出。术后应用青霉素、氨苄青霉素,但仍高热,拒乳,腹胀不缓解,术后第二天腹胀加重,腹透发现膈下大量游     

超声雾化猝死二例

超声雾化对呼吸道感染是一种有益的治疗方法 ,但对于严重呼吸道感染伴术后肠麻痹、腹胀的婴幼儿则是猝死的一个因素。例 1 :男 ,6个月。因阵发性哭吵2 4h伴呕吐、血便入院。体检 :精神差 ,T39℃ ,P 1 2 0次 /min ,R 30次 /min ,双肺可闻及较多细湿罗音 ,腹稍胀 ,未扪及包块 ,直肠空虚。诊断 :肠套叠 ;支气管肺炎。入院后作诊断性空气灌肠时 ,出现肠穿孔征象 ,即行剖腹探查。术中证实为肠套叠 ,结肠穿孔。整复肠套叠 ,修补结肠 ,行回肠双腔造瘘术。术后 1 6h ,患儿作超声雾化 ,此时患儿T 37℃ ,P 1 30次 /min ,R 2 9次 /min ,双肺痰鸣音。…     

腹腔镜下巨结肠根治术1例

患儿 :男 ,10个月。因腹胀、排大便困难 10个月入院。患儿出生后腹胀 ,第5ｄ经灌肠后排胎粪。平时靠家属用开塞露排大便。入院时腹胀 ,钡灌肠检查报告为 :先天性巨结肠症。每天给予生理盐水回流灌肠 1次 ,经 10ｄ时间的术前准备后 ,在气管插管全麻下行腹腔镜巨结肠根治术 (采用Ｓｏａｖｅ术式 ) :患儿平卧 ,通过腹壁插入气腹针 ,建立ＣＯ2气腹 ,压力为 10～ 11ｍｍＨｇ ,选右上腹处作 5ｍｍ套管针放 30°腹腔镜 ,左下腹处作 5ｍｍ套管针放抓钳牵提乙状结肠 ,右下腹处作 5ｍｍ套管针放分离钳、电凝钩等腹腔镜器械。先探查腹腔 ,病变为常见型…     

新生儿胃穿孔合并肠旋转不良一例并文献复习

目的:探讨新生儿胃穿孔合并肠旋转不良的临床特征及诊治要点,增强临床医生对此类疾病的认识。方法:对我院NICU收治的1例早产儿胃穿孔合并肠旋转不良患儿的临床资料进行回顾性分析,并结合文献资料进行讨论。结果:本例为36⁺¹周早产儿,因早产、生活能力低下1 h入院,入院48 h后出现腹胀及感染指标加重,根据症状、体征、腹部X线片、B超等辅助检查及腹腔探查,最终明确诊断,行胃穿孔修补术及肠扭转复位术,术后给予抗感染、营养支持对症治疗,好转出院。 结论:新生儿胃穿孔合并肠旋转不良好发于生后1周内,临床表现以腹胀为主,及早进行相关检查,必要时行腹腔探查术,对早期诊断及治疗很有帮助。     

幼女阴道下段部分闭锁致经血潴留误诊分析

例 1:女 ,12岁。因突然下腹疼痛伴恶心、呕吐 1ｄ急诊入院 ,患儿即往有多次类似发作史 ,入院后检查 :体温3 7.2℃ ,脉搏 116次 /ｍｉｎ ,呼吸2 0次 /ｍｉｎ ,血压 112 /67ｍｍＨｇ ,心肺正常 ,腹平坦 ,无明显腹胀 ,未见肠形、未触及包块。右侧腹及下腹有压痛 ,轻度肌紧张和反跳痛 ,麦氏点压痛不明显。实验室检查 :血红蛋白 13 0ｇ/Ｌ ,白细胞 9.7× 10 9/Ｌ ,中性 0 .76,淋巴 0 .4 1,尿常规正常。因考虑患儿有反复发作病史 ,诊断为慢性阑尾炎急性发作 ,于次日行阑尾切除术 ,术中见阑尾轻度充血 ,长约6ｃｍ ,与周围无粘连 ,手术顺利。术后3ｄ…     

星形诺卡氏放线菌腹膜炎1例报告

黄×,女,2(7/12)岁。因腹痛、腹胀6个月入院。患儿于6个月前出现腹痛,逐渐加重,以中上、右上腹为主,多为隐痛,时有剧痛。曾间断地用过多种抗菌素,病情无好转,腹胀渐加重,且伴不规则发热。3个月前曾在外院行剖腹探查术,从腹腔内引流出     

Comparison of patients with Kawasaki disease with retropharyngeal edema and patients with retropharyngeal abscess

Kawasaki disease with retropharyngeal edema (KD with RPE) is a rare complication, and it is diagnosed by neck CT. Most reported cases had a delayed diagnosis because those patients' conditions were misdiagnosed as retropharyngeal abscess (RPA). The purpose of this study was to differentiate KD with RPE from RPA. We performed a retrospective case–control study comparing children with KD with RPE to those with RPA hospitalized at the tertiary pediatric hospital in Tokyo between 2005 and 2011. The 39 patients revealing RPE on neck CT were divided into two groups: group A was classified as KD (n?=?21) and group B was classified as non-KD (n?=?18). Patients in group B were finally evaluated as having RPA clinically and were treated with antibiotic therapy. A significantly higher proportion of patients in group B complained of dysphagia (11 patients vs. 5 patients; p?=?0.0170) and neck pain (17 patients vs. 12 patients; p?=?0.0106). Neck CT revealed a ring enhancement (16 patients vs. no patients; p?<?0.0001) and mass effect in a greater proportion of patients in group B (11 patients vs. 1 patient; p?<?0.0003). Conclusion: Careful attention to manifestations and close analyses of CT imaging may allow clinicians to differentiate KD with RPE from RPA.     

Patients with moyamoya disease presenting with movement disorder

Moyamoya disease is a rare cerebrovascular disease characterized by idiopathic bilateral stenosis or occlusion of bilateral internal carotid arteries and the development of characteristic leptomeningeal collateral vessels at the base of the brain. Typical presentations include transient ischemic attacks or stroke, and hemorrhage. Presentation with movement disorders is extremely rare, especially in the pediatric population. The authors describe the cases of 4 children with moyamoya disease who presented with movement disorders. Among 446 patients (118 pediatric) with moyamoya disease surgically treated by the senior author, 4 pediatric patients had presented with movement disorders. The clinical records, imaging studies, surgical details, and postoperative clinical and imaging data were retrospectively reviewed. The initial presenting symptom was movement disorder in all 4 patients: chorea in 2, hemiballismus in 1, and involuntary limb shaking in 1. All the patients had watershed infarcts involving the frontal subcortical region on MR imaging. Additionally, 1 patient had a ganglionic infarct. Single-photon emission computed tomography studies showed frontoparietal cortical and subcortical hypoperfusion in all patients. Three patients had bilateral disease, whereas 1 had unilateral disease. All the patients underwent superficial temporal artery-middle cerebral artery bypass. Postoperatively, all 4 patients had complete improvement in their symptoms. The SPECT scans revealed normal perfusion in 3 patients and a small residual perfusion deficit in 1. Movement disorders are a rare presenting feature of moyamoya disease. Hypoperfusion of the frontal cortical and subcortical region was seen in all patients, and the symptomatology was attributed to ischemic dysfunction and imbalance in the cortical-subcortical-ganglionic-thalamic-cortical circuitry. Combined revascularization with superficial temporal artery-middle cerebral artery bypass and encephaloduroarteriosynangiosis leads to excellent results.