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題名 | Gastric Outlet Obstruction in Pediatric Patients=兒童非自發性胃幽門肌肉肥厚的胃出口阻塞 |
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作者 | 顏如貝; 江文山; | 書刊名 | 長庚醫學 |
卷期 | 29:4 民95.07-08 |
頁次 | 頁401-405 |
分類號 | 417.6242 |
關鍵詞 | 胃出口阻塞; 解剖學異常; 潰瘍性疾病; Gastric outlet obstruction; Anatomic abnormality; Peptic ulcer disease; |
語文 | 英文(English) |
中文摘要 | 背景:本研究報告在一個兒童醫院的病童羅患胃出口阻塞的病因、處置和結果。 方法:從西元1992年7月到西元2000年6月,共有142個病童藉由超音波、內視鏡或鋇劑消化道攝影被證實罹患胃出口阻塞,我們分析他們的病歷紀錄做成此研究。排除130位罹患自發性胃幽門肌肉肥厚的病人和1位罹患胃幽門肌肉痙攣的病人,共有11位病人選入本研究中。他們被分成解剖學異常組和潰瘍性疾病組。有1位病人各因解剖學異常組和潰瘍性疾病共發生兩次胃出口阻塞。在潰瘍性疾病組中有五位病人接受快速尿素酶試驗來偵測是否有胃幽門螺旋桿菌感染,有兩位病人抽血測試血液中胃泌素濃度。 結果:解剖學異常組共有6個病例,其平均診斷年齡為58個月大,男女比例為2比4。病因有胃幽門前腫瘤,網狀組織及胃扭轉。4個病人接受手術治療。有1個病人未繼續追蹤,其他病人在追蹤過程中(平均追蹤期間為24個月)沒有復發胃出口阻塞。潰瘍性疾病組共有6個病例,其平均診斷年齡為49個月大,全都為男性。病因有胃潰瘍和慢性十二指腸潰瘍。5個病人接受快速尿素酶試驗,其中有2個病人證實有胃幽門螺旋桿菌感染。4個病人藉由藥物治療即得到緩解另外兩位則接受手術才復原他們血液中的胃泌素濃度為正常。1個病人未繼續追蹤,其他病人在追蹤過程中(平均追蹤期間為27個月)沒有復發胃出口阻塞。 結論:排除自發性胃幽門肌肉肥厚,在我們的病人中造成胃出口阻塞的主因為潰瘍性疾病。在我們的研究中,如果是因解剖學異常造成胃出口阻塞,通常需要用手術方法來解決。如果是因潰瘍性疾病造成,通常使用較長時期的藥物可以解決胃出口阻塞。在我們的病人中,胃幽門螺旋桿菌染不具有重要角色。 |
英文摘要 | Methods: The medical records of 11 children with GOO not associated with idiopathic hypertrophic pyloric stenosis (IHPS) were reviewed. They were categorized into one group of anatomic abnormality (AA group) and one group of peptic ulcer disease (PD group). One case underwent episodes of GOO caused by anatomic abnormality and peptic ulcer disease, respectively. Results: Six cases belonged to the AA group. Mean age was 58 months with a male to female ratio of two to four. Underlying etiologies were prepyloric mass (2), web (2) and gastric volvulus (2). Four patients underwent surgery. One patient was lost to follow-up. GOO did not recur in the follow-up period (mean duration 24 months) in the remaining cases. One case in the AA group and the remaining five patients composed the PD Group. Mean age was 49 months and all were male. Underlying causes were gastric ulcers (4) and chronic duodenal ulcers (2). Two of the five patients had Helicobacter pylori infection found by rapid urease test. Four patients recovered after medical management and another two, with normal serum gastrin levels, underwent surgery because of poor response to medical treatment. One case was lost to follow-up. No recurrence of GOO was noted in the follow-up period (mean duration 27 months) in the remaining cases. Conclusions: In our study, peptic ulcer disease was as important as anatomic abnormalities as the etiology for GOO not associated with IHPS, and medical management could release GOO caused by it. Compared to adult patients, H. pylori infection played a less important etiologic role in pediatric patients with GOO. |
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