儿童三种上消化道溃疡的临床与胃镜特征

目的 探讨三种病因所致儿童上消化道溃疡临床和内镜形态特点,为儿童上消化道溃疡诊断与鉴别诊断及合理治疗提供依据.方法 对35例上消化道溃疡患儿临床资料进行总结分析,并通过胃镜检查,观察三种病因所致上消化道溃疡内镜形态特点.其中25例患儿取病变部位黏膜组织行病理检查,所有病例均进行幽门螺杆菌检测.结果 幽门螺杆菌相关性溃疡发病年龄最大,以中上腹痛为主,多伴有柏油样便,胃镜检查显示病变均在十二指肠球部,溃疡深浅不等,底部被覆白苔、黄白苔或血痂,多伴有球腔变形;腹型过敏性紫癜相关性溃疡年龄次之,多表现为全腹痛或脐周痛,可为黑便、血水样便或果酱样便,胃镜检查显示胃、十二指肠黏膜病变较弥漫,多发大小不等、深浅不一的出血、糜烂、溃疡,以十二指肠降部病变为著.非甾体抗炎药相关性溃疡发病年龄最小,均为婴幼儿,主要表现为呕吐,呕吐咖啡样物,胃镜检查显示病变均见于胃窦部,溃疡较表浅,周围黏膜充血水肿.结论 三种不同病因所致儿童上消化道溃疡临床及胃镜表现不同,据此可为儿童上消化道溃疡临床诊断、鉴别诊断及治疗提供依据.

The Clinical and Endoscopic Features of Upper Alimentary Tract Ulcer Caused by Three Factors on Children

Objective To investigate clinical and endoscopic characteristics of upper alimentary tract ulcer caused by three kinds of causes on children, in order to offer a guide for its diagnosis and differential diagnosis and reasonable therapy. Methods Analysed clinical data of 35 cases with upper alimentary tract ulcer, and observed the endoscopic morphological characteristics by gastroscopy. 25 patients among them were taken lesion mucosa pathological examination, all patients underwent Helicobacter pylori detection. Results The age of H. pylori- related ulcer were the oldest and the pain was mainly on the middle and upper abdominal, often accompanied with asphalt liked stool. Gastroscopy showed deep or shallow. Ulcer on duodenal bulb with the coating of white fur, yellow fur or blood scab. The age of abdominal anaphylactoid purpura followed. It mainly showed the entire abdominal or umbilical pain and the stool can be black, like anthrax or jam. Endoscopic examination revealed gastric and duodenal mucosal lesions were diffuse bleeding, dissipated and even ulcer, become more serious in the descending duodenum. The age of non-steroidal anti-inflammatory drugs induced ulcer were the youngest. They were infants and young children, mainly showed vomiting. Endoscopic examination revealed lesions in gastric antrum and the superficial ulcer surrounded by mucosal congestion and edema. Conclusion Clinical and endoscopic features are different on children with upper alimentary tract ulcers caused by three different causes. They can provide guide for the clinical diagnosis, differential diagnosis and therapy of children with upper alimentary tract ulcer