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目的:探讨急诊胃镜检查在小儿上消化道出血中的临床应用价值。方法:选择我院2009年5月至2011年5月收治的小儿上消化道出血患者40例,采用急诊胃镜检查,对其临床资料进行分析。结果:本组40例患儿,胃镜均一次插入成功,无穿孔、窒息、出血等严重并发症发生。包括消化性溃疡20例,占50%,其中,十二指肠溃疡16例,单纯球后溃疡2例,球部溃疡14例;胃溃疡4例。急性胃黏膜病变10例,占25%;浅表性胃炎伴十二指肠溃疡及十二指肠球部糜烂性炎症各5例,均占12.5%。HP合并感染16例,其中,胃溃疡1例,阳性率为6.3%;十二指肠溃疡11例,阳性率为68.8%;胃黏膜急性病变3例,阳性率为18.8%;其他1例,阳性率为6.3%。所有患者的病理检查结果显示为轻-中度慢性活动性炎症。胃镜检查下大部分患儿均无活动性出血表现,病灶局部在检查中渗血1例,给予去甲肾上腺素局部止血处理后好转。结论:对小儿上消化道出血患儿尽早实施急诊胃镜检查,做充分的术前准备,可达到提高确诊率和治愈率的目的。采用内科保守治疗的方法多可获得理想预后,患儿合并大出血时可考虑行介入或手术治疗,对病情进行控制,从而改善患儿的生存质量。
Objective: To investigate the clinical value of emergency gastroscopy in children with upper gastrointestinal bleeding. Methods: Forty children with upper gastrointestinal bleeding admitted to our hospital from May 2009 to May 2011 were enrolled. Emergency gastroscopy was used to analyze the clinical data. Results: In this group of 40 children, the gastroscope was successfully inserted one time without any serious complications such as perforation, asphyxia and hemorrhage. Including peptic ulcer in 20 cases, accounting for 50%, of which 16 cases of duodenal ulcer, simple ball ulcer in 2 cases, ball ulcer in 14 cases; 4 cases of gastric ulcer. Acute gastric mucosal lesions in 10 cases, accounting for 25%; superficial gastritis with duodenal ulcer and duodenal erosive inflammation in 5 cases, accounting for 12.5%. HP combined infection in 16 cases, of which 1 case of gastric ulcer, the positive rate was 6.3%; 11 cases of duodenal ulcer, the positive rate was 68.8%; 3 cases of gastric mucosal acute lesions, the positive rate was 18.8%; the other 1 case, The positive rate was 6.3%. The pathological findings of all patients showed mild to moderate chronic active inflammation. Gastroscopy showed no active bleeding in most of the children, local lesions in the examination of bleeding in 1 case, given norepinephrine local hemostasis improved after treatment. Conclusion: Early emergency gastroscopy in children with upper gastrointestinal bleeding, adequate preoperative preparation, can achieve the purpose of improving the diagnosis rate and cure rate. The use of conservative treatment of internal medicine and more to obtain the desired prognosis, with bleeding in children with or without intervention may be considered to control the disease, so as to improve the quality of life of children.