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頁籤選單縮合
題名 | Clinical Spectrum of Alimentary Tract Duplication in Children=兒童腸胃道複製畸形之臨床分析 |
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作者 | 郭馨璟; 李宏昌; 施純宏; 許錦城; 張北葉; 王念陸; | 書刊名 | 臺灣兒科醫學會雜誌 |
卷期 | 45:2 民93.03-04 |
頁次 | 頁85-88 |
分類號 | 417.54 |
關鍵詞 | 兒童; 腸胃道複製畸形; Alimentary tract duplication; Ectopic gastric mucosa; Cloacal extrophy; Gastroschisis; Intussusception; |
語文 | 英文(English) |
中文摘要 | 腸胃道複製畸形是一種少見的先天性異常。我們收集十年來住院的兒科病人中被診斷出腸胃道複製畸形的十六個病例,回溯病人的病史並分析男女的比例,出現症狀的年紀,臨床症狀的表現,腸胃道複製畸形的大小,存在的位置,是否會併有異位的黏膜存在,是否有合併症,是否合併其他異常的存在,以及預後。在臨床症狀的表現上不盡相同,但以間歇性的嘔吐爲最常見的表現,有過半數的病人在一歲之前就有臨床症狀的表現。年紀較大的孩童可以自己表達,都以肚子疼痛爲其主訴。分析病人的臨床症狀表現:50%的病人出現嘔吐,50%以肚子疼痛爲主訴,30%的病人出現腹脹,20%的病人可以摸到腹部腫塊,13%出現腹膜炎,6%解血便,6%合併發燒,2個病人以腸套疉來表現,6%則以非特異性的便秘爲症狀表現。這在以前的研究報道中是很少提及的症狀表現,也因爲如此,一個一十七歲的女孩,長期爲便秘所苦,一直到接受大腸鋇劑攝影檢查,在懷疑是巨結腸症的診斷下,施以剖腹探查手術,結果意外發現在結腸有腸胃道複製畸形的存在。因爲便秘及腹痛是非特異性的症狀表現,在臨床上常常會造成診斷的延續。腸胃道複製畸形的分佈:在胃有三個病例(18.75%),迴腸有十二個病例(63%),闌尾有一個病例(18.75%)直腸有一個病例(5%)。迴腸是最常見發生腸胃道複製畸形的位置,這和以前研究報告的結果是一致的。合併有異位的黏膜存在的比例爲25%,四個病人當中有三個胃複製畸形。病人的預後大致良好,除了兩個病人例外。其中一個病人有個複製畸形(分佈在腸胃道,尿道)另外還合併腹製畸形,泄殖腔外翻等異常。另一新生兒則是因乙狀結腸腸胃道複製畸形的穿孔併發腹膜炎而死亡。 |
英文摘要 | Alimentary tract duplication is a rare congenital malformations. Sixteen patients admitted to our pediatric ward were enrolled in a ten-year study over the most recent decade. In this paper, we trace their history and retrospectively analyze sex, age, clinical presentations, duplication size and location, presence of ectopic tissue, complications and additional associated anomalies and prognosis. The duplications were cystic in all cases except one tubular duplication of the colon. The cases included duplication of the stomach in 3 cases (19%); ileum in 12 cases (63%); appendix in 1 case (5%); colon in 3 cases (16%); and rectum in 1 case (5%). The most frequent symptom was intermittent vomiting, half of which occurred before 1 year of age. Other symptoms included abdominal pain (50%), abdominal distension (30%), palpable mass (20%), peritoneal sign (13%), bloody stool (6%), fever (6%), and constipation (6%). The outcome was good, except in 2 patients, 1 of whom died of a perforation of the sigmoid colon duplication, and another who was complicated with multiple congenital anomalies. Conclusion: In our series, the average time period from the initial onset of symptoms to the diagnosis was 6.9 days, with only one exception (a 17-year-old girl who had habitual constipation). The constipation in the single exception was not a specific presentation, which may have delayed the diagnosis. Pediatric patients with unexplained gastrointestinal symptoms must be diagnosed for the possibility of alimentary tract duplication, even though it rarely occurs. Ultrasonography is helpful in diagnosing a duplication, as it will identify a three-layered image representing the duplication cyst, common wall, and outer bowel wall. These features have proven useful for establishing the correct diagnosis or ruling out alimentary tract duplication where surgery was indicated anyway. |
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