中国实用儿科杂志

中国实用儿科杂志

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儿童消化性溃疡穿孔临床特征及其危险因素分析

  

  1. 郑州大学附属儿童医院消化内科，河南  郑州  450018
  • 出版日期:2020-11-06 发布日期:2020-12-10

Clinical characteristics and risk factors of peptic ulcer perforation in children

  1. Department of Gastroenterology，Children’s Hospital Affiliated to Zhengzhou University，Zhengzhou  450018，China
  • Online:2020-11-06 Published:2020-12-10

摘要： 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。

关键词: 儿童, 消化性溃疡, 穿孔, 危险因素

Abstract: Objective　To explore the clinical characteristics and risk factors of peptic ulcer with perforation in children，and to provide reference for clinical intervention. Methods　The clinical data of 688 cases of peptic ulcer diagnosed by endoscopy in Department of Gastroenterology，Children’s Hospital Affiliated to Zhengzhou University，from December 2014 to December 2019 were analyzed retrospectively. All the cases were divided as 47 cases of peptic ulcer with perforation group and 641 cases of peptic ulcer group. Demographic factors，incidence rate，clinical features，etiology，symptoms，endoscopic or surgical treatment and clinical outcome were analyzed. Risk factors for perforation of peptic ulcer were analyzed by multivariate logistic regression analysis. Results　A total of 14916 cases of gastroscopy were collected in the study，and 688 cases（4.61%） of peptic ulcer were screened，among which 47 cases（6.83%） were complicated with perforation. There were 412 boys and 276 girls，with a median age of 8.5 years（1 month to 14 years old）. A total of 485 cases（70.49%） lived in rural areas；353 cases（51.31%） had no family history；424 cases（61.63%） had no peritoneal stimulation sign；228 cases（33.14%） had gastric antrum ulcers；264 cases（38.37%） had duodenal bulb ulcers；in 461 cases（67.01%） the diameter of ulcers was  less than 10 mm；465 cases（67.59%） had single ulcer；the causes of ulcer were mainly infection of Helicobacter pylori（Hp）（306 cases，44.48%） and nonsteroidal anti-inflammatory drugs（NSAID）（109 cases，15.84%）. The average age of perforation group was significantly lower than that of non-perforation group［（5.3±1.2） years old vs.（9.8±3.5） years old，P＜0.001］；ulcers with perforation were mostly found in rural children（38 cases，80.85%）；fever，WBC and CRP were more likely to occur in perforation group，and there were significant differences between the two groups（P＜0.05）；gastric antrum and duodenal bulb were the most common sites of perforation，which were similar to those of ulcer；the diameters of ulcers were more than or equal to 10 mm in perforation group（35 cases，74.47%），and the proportion of multiple ulcer in perforation group（33 cases，70.21%） was significantly higher than that in non-perforation group（P＜0.001）；the main cause of peptic ulcer perforation in children was HP infection（28 cases，59.57%） and NSAID（8 cases，17.02%）. The prognosis of laparotomy was good，but the hospitalization period of laparoscopy was shortened. Multivariate Logistic regression analysis indicated that age，ulcer location，ulcer size and etiology were independent risk factors for perforation. Conclusion　There are complicated risk factors for peptic ulcer complicated with perforation. Early diagnosis and reasonable treatment can effectively shorten the course of disease and improve the prognosis.

Key words: child, peptic ulcer, perforation, risk factor