电子胃肠镜在小儿消化道出血中的临床应用

Clinical application of electronic gastroscope in pediatric alimentary tract hemorrhage

摘要:

回顾性分析进行内镜检查的14岁以下儿童消化道出血的发病年龄、出血原因和出血部位，进一步研究不同原因的消化道出血对外周血红细胞（RBC）、血红蛋白（Hb）和红细胞压积（HCT）的影响。方法?选择2012年1月－2018年9月该院消化科因消化道出血住院的123例患儿，对发病年龄、临床表现、出血病因、出血部位以及RBC、Hb和HCT进行归纳总结。结果?儿童消化道出血多见于学龄前期儿童，平均发病年龄（4.55±3.90）岁，临床以呕血73例、便血50例、腹痛17例为主要表现，上消化道出血105例，下消化道出血18例。上消化道出血原因为胃溃疡28例、出血性或糜烂性胃炎27例和十二指肠球部溃疡19例等，出血部位于胃体43处、胃窦39处和十二指肠球部16处等。下消化道出血原因为Meckel憩室7例、直肠结肠炎5例、肠息肉4例，出血部位于小肠处7例、直肠处7例和乙状结肠处6例。十二指肠球部溃疡、Meckel憩室、食道胃底静脉曲张导致的消化道出血，其RBC、Hb和HCT影响较大（P <0.05）。结论?儿童上消化道出血发病率明显高于下消化道出血；上消化道出血原因以胃溃疡、出血性或糜烂性胃炎、十二指肠球部溃疡最为常见，出血部位以胃体、胃窦、十二指肠球部最常见。下消化道出血原因以Meckel憩室、直肠结肠炎、结肠息肉最为常见，出血部位以小肠、直肠、乙状结肠最常见，而十二指肠球部溃疡、Meckel憩室、食道胃底静脉曲张导致消化道出血对患儿临床危害较大，风险较高。

Abstract:

To retrospectively analyze onset ages, the causes and locations of gastrointestinal hemorrhage in children under 14 years old. The effects of different bleeding causes on red blood cells, hemoglobin and hematocrit in peripheral blood were further studied. Methods Data from 123 case children with gastrointestinal hemorrhage from January 2012 to September 2018 were summarized about the age of onset, clinical manifestation, etiology, bleeding site and red blood cells, hemoglobin, hematocrit in peripheral blood. Results Gastrointestinal bleeding in children is more common in preschool children. The manifestations mainly include hematemesis in 73 cases, bloody stool in 50 cases, abdominal pain in 17 cases. The endoscopic examination found upper gastrointestinal hemorrhage in 105 cases and gastrointestinal bleeding in 18 cases. The upper gastrointestinal hemorrhage was often caused by gastric ulcer 28 cases, hemorrhagic or erosive gastritis 27 cases and duodenal bulb ulcers 19 cases and so on. The bleeding site was usually seen in the stomach in 43 cases, the stomach sinus in 39 cases and the duodenal bulb in 16 cases. The causes of lower gastrointestinal hemorrhage were Meckel diverticulum in 7 cases, rectal colitis in 5 cases, and intestinal polyps in 4 cases. Bleeding site was seen in small intestine in 7 cases, rectum in 7 cases, sigmoid colon in 6 cases. The red blood cells, hemoglobin, and hematocrit in peripheral blood were affected obviously when bleeding caused by Duodenal bulbar ulcer, Meckel diverticulum, and varices in the stomach of the esophagus (P < 0.05). Conclusion The upper gastrointestinal hemorrhage is more common than lower gastrointestinal hemorrhage for children. The causes of upper gastrointestinal hemorrhage were gastric ulcer, hemorrhagic or erosive gastritis and duodenal bulbar ulcer. The most common causes of lower gastrointestinal hemorrhage are Meckel diverticulum, rectal colitis and colonic polyp, while the most common site of hemorrhage is small intestine, rectum and sigmoid colon. Duodenal bulbar ulcer, Meckel diverticulum, and esophageal varices leading to gastrointestinal hemorrhage are of great clinical harm to the children.