小儿幽门螺杆菌感染伴消化性溃疡药物治疗研究

目的比较不同方案治疗小儿消化性溃疡的疗效和幽门螺杆菌(Hp)根除率,并随访2年,以评价Hp在小儿消化性溃疡愈合和复发中的作用.方法113例Hp感染伴消化性溃疡患儿分4组接受治疗.A组奥美拉唑0.8mg/(kg     

三联短程疗法治疗胃溃疡27例

2 0 0 0年 9月～ 2 0 0 2年 11月采用蒙脱八面石思密达 +替硝唑 +奥美拉唑三联短程疗法 (以下简称三联疗法 )治疗小儿消化性溃疡 2 7例 ,疗效肯定 ,现报告如下。对象与方法一、一般资料　均经小儿纤维胃镜OlympusGIF -XQ2 0检查证实为胃活动期溃疡 ,距幽门 2～ 3cm胃窦处取一块黏膜行快速尿素酶试验 ,组织学检查Giemsa染色检查幽门螺杆菌 (Hp) ,两项均阳性为Hp阳性 ,诊断标准按小儿慢性胃炎、消化性溃疡诊断治疗推荐方案[1] 。以 2 0 0 0年 9月～2 0 0 2年 11月门诊和住院患儿 2 7例为治疗组 ,均为初诊病例 ,2周内未用过抗溃疡药物和…     

小儿幽门前瓣膜症四例分析

幽门前瓣膜是引起小儿幽门梗阻的原因之一。临床实际中常与幽门肥厚性狭窄混淆 ,但其病理、临床及Ｘ线表现均有不同之处 ,幽门肥厚性狭窄必须手术治疗 ,而幽门前瓣膜症则有非手术治疗的可能性[1 ,2 ] 。现将我院 1994～ 1999年收治的 4例小儿幽门前瓣膜症报告如下。对象及方法本组 4例 ;年龄 2岁 2例 ,4岁 2例 ;发病时间 10ｄ至 2年不等 ,均因间断性呕吐就诊 ,呕吐物均为胃内容物。患儿伴有Ⅰ度～Ⅲ度营养不良 ,体格检查上腹部肿块 3例为阴性 ,1例可疑。 4例中有 2例以“胃肠功能紊乱”住内科治疗 ,因Ｘ线诊断幽门梗阻后转外科手术。 4例术…     

幼儿先天性幽门窦前瓣膜症的诊治体会

目的探讨先天性幽门窦前瓣膜症的诊治。方法回顾性分析6例幽门窦前瓣膜症病例资料，均施行手术治疗，其中胃十二指肠侧侧(菱形)吻合2例，瓣膜切除幽门成型2例，胃空肠吻合2例：结果6例均临床治愈，未再呕吐，营养状况显著改善。结论对婴幼儿反复非胆汁性呕吐，经保守治疗无效时应考虑该病，结合钡餐及胃镜不难做出诊断；根据患儿幽门局部病变及全身情况选择术式，以求既符合生理又避免术后并发症的发生。     

儿童消化性溃疡穿孔的临床处理探讨

目的 探讨儿童消化性溃疡穿孔的外科治疗。方法 回顾性分析11例胃、十二指肠溃疡穿孔患儿病例资料。结果 11例患儿均行单纯穿孔修补术，愈后良好。结论 单纯穿孔修补术具有操作简单、效果好、并发症少、不影响生长发育的优点，在治疗儿童的胃、十二指肠溃疡穿孔时为首选术式。     

Heineke-Mikulicz幽门成形术在儿童胃流出道梗阻良性病变中的应用

目的探讨Heineke-Mikulicz幽门成形术(Heineke-Mikulicz pyloroplasty, HMP)在儿童胃流出道梗阻良性病变中的应用指征及手术疗效。方法回顾性分析广州医科大学附属广州市妇女儿童医疗中心胃肠外科2015年8月至2021年1月收治的11例因良性胃流出道梗阻病变接受HMP患儿临床资料。其中4例为消化性溃疡致幽门或十二指肠球部狭窄;3例为胃壁肿物(2例为异位胰腺, 1例为胃重复畸形);2例为嗜酸性粒细胞性胃肠炎致幽门狭窄;1例为先天性肥厚性幽门狭窄幽门环肌切开术后幽门再梗阻;1例为化学性损伤致胃窦近幽门处狭窄。收集所有患儿年龄、手术情况及术后恢复情况。结果 11例患儿中, 男5例、女6例;平均年龄5岁1个月。均成功施行HMP, 其中9例行开放手术, 2例行腹腔镜手术。手术时间(162±92)min, 术中出血量(10±3)mL, 术后住院时间(12±4)d。11例共行14次手术。1例化学性损伤患儿出院时需半流质饮食, 其余10例恢复至正常饮食。术后随访(38±23)个月, 术后6个月随访有2例饱食后偶有轻微腹痛, 1例偶有胃潴留, 均经保守治疗好转;术后...     

小儿腹部肿瘤的诊治经验的探讨

目的对小儿腹部实体肿块常见类型及肿瘤的早期诊断、外科治疗适应证及手术技巧进行深入讨论。方法总结了1993～2003年十年间我院共收治小儿腹部肿瘤患儿29例，其中22例接受手术，除1例术后死亡，其他21例预后良好。回顾性研究其相关因素。结果22例腹部肿瘤患儿，其中16例肝母细胞瘤，1例术后因凝血功能障碍死亡，2例肾母细胞瘤，3例畸胎瘤，1例神经母细胞瘤。术后恢复良好。肾母细胞瘤术后均行化疗。术后患儿未发生腹腔大出血及邻近器官损伤。结论小儿腹部肿瘤要早期诊断、及时治疗，术前要认真检查及分析，根据病理分型及患儿耐受能力进行合理的个体治疗方案。     

钠络酮治愈假性肠梗阻2例

例１女，１４岁。１９８４年１０月８日出生，生后间断呕吐，行钡餐检查示幽门梗阻伴肠回转不全，于１９８５年１２月在我院行幽门成型、ｌａｄｄｅｒ’ｓ手术及阑尾切除术。术后１月持续呕吐，腹平片显示机械性肠梗阻，遂行肠粘连松解术。患儿第２次术后反复出现呕吐症状...     

儿童消化性溃疡内镜及临床3年随访研究

随着消化内镜在儿科的普及应用,儿童消化性溃疡的检出率明显上升,我院2001年9月至2008年3月对3183例具有上消化道症状的患儿行胃镜检查,检出消化性溃疡365例.我们对此365例溃疡患儿的内镜改变,幽门螺杆菌(Hp)感染情况进行了随访,现报告如下.     

非标准式胃部分切除术治疗消化性溃疡

目的：通过对25例小儿消化性溃疡的临床资料分析，探讨非标准式胃部分切除术的治疗效果。方法：观察指标包括手术后早、晚期并发症，溃疡复发率，生长发育参数及智商等。结果：手术创伤减少，病儿可耐受手术，术后1例复发，10例血红蛋白及红细胞降低，除1例先天愚型外，全部病例发育商正常。结论：非标准式胃部分切除术治疗小儿消化性溃疡疗效基本满意，但对小儿生长发育有一定影响。     

Acquired non hypertrophic pyloric stenosis in children]

Pediatric non hypertrophic pyloric stenosis (NHPS) are uncommon. Their causes and treatments are debated.Material and methodRetrospective review of all cases of NHPS from 3 pediatric surgery services during the period 1984–2002.ResultsSix children, aged 17 months to 15 years, underwent surgery for NHPS. Clinical symptoms, food vomiting and loss of weight, were present for several weeks before the diagnosis of NHPS was made. The diagnosis was peptic stenosis in 3 cases and has not been established in 3 cases. Search for Helicobacter pylori was negative in all cases. Failure of specific medical treatment and endoscopic dilatations led to pyloric resection in 3 cases and pyloroplasty in 3 cases. Post operative course was uneventful with normal oral feeding and normalisation of weight status. Histologic data were aspecific. No recurrence was observed.DiscussionWe discuss the origin of the pyloric stenosis, regarding clinical, operative and pathological data: were the stenosis the cause or consequence of peptic ulcer? Peptic disease is always advocated, but difficult to prove and may be excessively incriminated. Late symptomatic congenital and acquired idiopathic pyloric stenosis should be recalled. In all cases of proved pyloric stenosis, after failure of medical and endoscopic treatment, a simple surgical procedure (pyloroplasty) associated with medical treatment seems to be effective.ConclusionThe diagnosis of NHPS should be suspected in a child with food vomiting and loss of weight if his age is not concordant with hypertrophic pyloric stenosis. Upper gastro-intestinal series and endoscopy are diagnostic. The precise cause of the stenosis is more difficult to asses. When the medical treatment fails, a pyloroplasty is usually curative.     

Rare causes of gastric outlet obstruction in children

Gastric outlet obstruction (GOO) presenting beyond the newborn period is a relatively rare condition, when infantile hypertrophic pyloric stenosis (IHPS) is excluded. This report describes the clinical features, evaluation and management of 18 patients with GOO which was not caused by IHPS. The sex, age, and main presenting features were recorded on admission. Hemoglobin estimation, serum chemistry and blood gas analysis were also assessed in these patients. The diagnosis was confirmed with gastrointestinal barium, B ultrasound, gastroscopy, or at surgery. Some of them underwent gastroscopy with biopsy sampling for rapid urease test or histologic examination with Giemsa stains for Helicobacter pylori. Thirteen patients had peptic ulcer disease, of which six were successfully treated with medications. While the other seven needed operative management which included Heineke-Mikulicz pyloroplasty, gastroduodenostomy or gastrojejunostomy, respectively. All the patients who had Heineke-Mikulicz pyloroplasty or gastrojejunostomy developed bile reflux gastritis that could be alleviated with omeprazol. None of the patients developed dumping syndrome, failing to thrive, or anemia. Three children with antral diaphragm recovered without any complications by diaphragm excision with Heineke-Mikulicz pyloroplasty. The pylorus was compressed by fibrotic band in one 30-month boy, and he recovered uneventfully with Heineke-Mikulicz pyloroplasty during 10-year follow-up. Gastric outlet obstruction secondary to ingestion of sulfuric acid was noted in one patient, and he was successfully treated with gastroduodenostomy. Our data suggests that the satisfactory results could be expected in children with GOO with different therapeutic modalities based on the specific cause and degree of obstruction.     

Stenosing gastroduodenal ulcer in children. Apropos of 3 cases

Three cases of stenosing peptic ulcers in young children (age 21 months, 6 years and 8 years) are reported. During infancy, peptic ulcer is the main cause of pyloric stenosis after pyloric hypertrophy. The stenosis reveals or complicates primary gastric or duodenal ulcers. A complete cure can only be obtained with medical treatment.     

Idiopathic focal foveolar hyperplasia in infants

Idiopathic focal foveolar hyperplasia (FFH) is a rare cause of gastric outlet obstruction in infants. We present two cases, including the first reported association with infantile hypertrophic pyloric stenosis. The diagnostic ultrasound appearance of FFH is described. Optimal treatment is surgical excision of the involved mucosa with pyloroplasty or pyloromyotomy.     

Peptic ulcer disease in childhood in Zaria, Nigeria

Over a 10-year period in a busy paediatric surgical unit, six children were operated upon for peptic ulcer disease, four of whom presented with complications (pyloric stenosis, two; perforation, one; bleeding, one). Truncal vagotomy with a drainage procedure was the operation of choice in five of the children in whom there were no complications. One child suspected of having Zollinger-Ellison syndrome had recurrence of symptoms. Symptoms of peptic ulcer disease in children are non-specific, and in our environment such symptoms are frequently considered to be due to parasitic infestation. Barium meal is not very sensitive in diagnosis in children, and the relative lack of availability of endoscopic services limits pre-operative diagnosis. It is suggested that peptic ulcer disease be considered in children who have persistent or recurrent abdominal pain of obscure aetiology.     

幽门前瓣膜症：附4例报告

阐述幽门前瓣膜症的病因、分类及手术方式的选择。１９８８～１９９４年收治４例均为有孔瓣膜型，症状于出生１个月后出现。Ｂ超检查示幽门完全梗阻１例，不完全梗阻３例，均未见幽门肿块。ＧＩ检查常先行胃肠减压等治疗后继用少量造影剂检查，完全和不完全梗阻各１例，无征象２例。瓣膜位于胃窦部１例行单纯瓣膜切除术；幽门部２例行瓣膜切除加幽门成形术；合并胃溃疡１例行胃部分切除毕Ⅰ式吻合术。随访１～７年均无异常。本病罕见，症状出现的迟早取决于梗阻的严重程度。ＧＩ检查中注意胃肠减压等治疗对造影的影响。Ｂ超和内窥镜检查对确立诊断有重要价值。应根据瓣膜的解剖部位及合并症选择手术方式。     

小儿幽门管溃疡36例

目的 探讨小儿幽门管溃疡的临床特点、诊断及治疗方法.方法 回顾性分析36例(男22例,女14例;年龄6个月～12岁)幽门管溃疡的的临床表现、胃镜和钡餐检查特点及其治疗和预后.结果 以呕吐为首发表现的患儿33例(占91.7%),伴食欲减退30例,腹痛20例,黑便、消瘦各12例,面色苍黄、腹上区包块各10例;合并不同程度贫血29例,代谢性碱中毒27例,低钠、低钾、低氯血症各18例.胃镜首次检查能通过幽门并发现幽门管溃疡9例,并幽门梗阻且胃镜前端不能通过者27例;对胃镜不能通过者行稀钡餐检查,结果显示幽门管溃疡6例,幽门不完全性梗阻21例.23例(63.9%)经内科保守治疗治愈,13例(36.1%)经手术治疗治愈.结论 小儿幽门管溃疡的首发表现为呕吐,胃镜和钡餐检查是确诊幽门管溃疡的主要手段.治疗方面以内科保守治疗为主,幽门管溃疡由于其解剖位置特异,其抑酸治疗的疗程适当延长,主张以4～6周为1个疗程抑酸治疗,患儿不易复发;对少数难以控制的大出血者、幽门完全性梗阻经保守治疗72 h无效者及易复发的多发性幽门管溃疡者应选择手术治疗.     

Is peptic ulcer a common cause of upper gastrointestinal symptoms?

 The aim of the study was to investigate retrospectively a cohort of children with peptic ulcer disease during a period that covers the recent changes in diagnosis and management of the disease. Over a period of 9 years, 2550 children underwent upper gastrointestinal endoscopy for various reasons. All children, in whom a diagnosis of primary peptic ulcer was established, were included in the study. Previous and current medical history, family history, endoscopic and histological outcome were evaluated and the children were regularly followed-up on an out-patient basis. Primary peptic ulcer was diagnosed in 52 (10 gastric and 42 duodenal, 2%) out of 2550 children. The median age of children with gastric ulcer was 6.5 years, whereas of those with duodenal ulcer was 10.5 years (P=0.04). With regard to clinical symptoms no significant difference was found between children with and without ulcer. The prevalence of Helicobacter pylori infection was significantly higher in children with duodenal ulcer (62%) compared to those with gastric ulcer (20%; P<0.001). At first follow-up visit, 1 month after the end of treatment, 19 symptomatic children underwent a repeat endoscopy, which showed ulcer healing in 95% and failure in H. pylori eradication in 27%. During the long-term follow-up (median 3.5 years), six children became symptomatic. Two of them had duodenal ulcer associated with positive H. pylori. Conclusion Peptic ulcer disease is an uncommon disorder in childhood with non specific clinical features; it seems that efficient treatment and successful Helicobacter pylori eradication result in clinical improvement and cure as well as in long-term healing of ulcers. Received: 25 September 2000 and in revised form: 22 February and 28 March 2001 / Accepted: 29 March 2001     

儿童消化性溃疡穿孔临床特征及其危险因素分析

目的　探讨小儿消化性溃疡并发穿孔的临床特征及其危险因素,为临床干预提供参考依据。方法　回顾性分析2014年12月至2019年12月郑州大学附属儿童医院688例胃镜检查诊断为消化性溃疡患儿的临床资料。患儿分为消化性溃疡合并穿孔组47例和非穿孔组641例。分析人口统计学、发病率、临床特征、病因、症状、内镜或外科处理方法及临床转归,通过多因素Logistic分析消化性溃疡并发穿孔的危险因素。结果　本组共14916例行胃镜检查,筛查消化性溃疡688例（4.61%）,其中合并穿孔47例（6.83%）。男性412例、女性276例,中位年龄8.5岁（1月龄～14岁）。溃疡患儿居住农村为主485例（70.49%）;无家族史353例（51.31%）,穿孔不伴腹膜刺激征424例（61.63%）;溃疡位置主要为胃窦228例（33.14%）,十二指肠球部264例（38.37%）;溃疡多以直径＜10 mm为主（461例,67.01%）,单发较多（465例,67.59%）;溃疡因幽门螺旋杆菌（Hp）感染（306例,44.48%）和非甾体类抗炎药（109例,15.84%）为主。穿孔组年龄明显低于非穿孔组［（5.3±1.2）岁 vs.（9.8±3.5）岁,P＜0.001］;溃疡合并穿孔多发生于农村患儿（38例,80.85%）;穿孔组更易出现发热、 白细胞及C反应蛋白升高,两组比较差异有统计学意义（P＜0.05）;穿孔好发位置为胃窦、十二指肠球部,与溃疡好发位置基本重叠;穿孔组溃疡直径≥10 mm（35例,74.47%）,穿孔组多发溃疡比例（33例,70.21%）显著高于非穿孔组（P < 0.001）;引起儿童消化性溃疡穿孔主要原因为Hp感染（28例,59.57%）和NSAID（8例,17.02%）。开腹手术预后好,但腹腔镜住院周期明显缩短。多因素Logistic回归分析提示年龄、溃疡位置及大小、病因是穿孔发生的独立危险因素。结论　消化性溃疡并发穿孔存在复杂的危险因素,尽早合理治疗利于缩短病程、提高预后。     

儿童消化性溃疡穿孔临床特征及其危险因素分析

目的　探讨小儿消化性溃疡并发穿孔的临床特征及其危险因素,为临床干预提供参考依据。方法　回顾性分析2014年12月至2019年12月郑州大学附属儿童医院688例胃镜检查诊断为消化性溃疡患儿的临床资料。患儿分为消化性溃疡合并穿孔组47例和非穿孔组641例。分析人口统计学、发病率、临床特征、病因、症状、内镜或外科处理方法及临床转归,通过多因素Logistic分析消化性溃疡并发穿孔的危险因素。结果　本组共14916例行胃镜检查,筛查消化性溃疡688例（4.61%）,其中合并穿孔47例（6.83%）。男性412例、女性276例,中位年龄8.5岁（1月龄～14岁）。溃疡患儿居住农村为主485例（70.49%）;无家族史353例（51.31%）,穿孔不伴腹膜刺激征424例（61.63%）;溃疡位置主要为胃窦228例（33.14%）,十二指肠球部264例（38.37%）;溃疡多以直径＜10 mm为主（461例,67.01%）,单发较多（465例,67.59%）;溃疡因幽门螺旋杆菌（Hp）感染（306例,44.48%）和非甾体类抗炎药（109例,15.84%）为主。穿孔组年龄明显低于非穿孔组［（5.3±1.2）岁 vs.（9.8±3.5）岁,P＜0.001］;溃疡合并穿孔多发生于农村患儿（38例,80.85%）;穿孔组更易出现发热、 白细胞及C反应蛋白升高,两组比较差异有统计学意义（P＜0.05）;穿孔好发位置为胃窦、十二指肠球部,与溃疡好发位置基本重叠;穿孔组溃疡直径≥10 mm（35例,74.47%）,穿孔组多发溃疡比例（33例,70.21%）显著高于非穿孔组（P < 0.001）;引起儿童消化性溃疡穿孔主要原因为Hp感染（28例,59.57%）和NSAID（8例,17.02%）。开腹手术预后好,但腹腔镜住院周期明显缩短。多因素Logistic回归分析提示年龄、溃疡位置及大小、病因是穿孔发生的独立危险因素。结论　消化性溃疡并发穿孔存在复杂的危险因素,尽早合理治疗利于缩短病程、提高预后。