论文部分内容阅读
例1:生后20天。因嗜睡半天,醒后哭闹、拒乳、面色苍白、出汗入院。查体无明显异常,腹部X线示无液平。疑为低血糖,给予高渗糖、维生素C等静注,仍嗜睡。入院后4小时出现反复呕吐、剧烈哭闹,再次查体于左季肋区扪及腊肠样包块,1小时后排果酱样血便,诊为肠套叠,转外科治疗。 例2:生后26天。吐泻、阵阵哭闹1天,日排水样便10余次,拟诊为肠炎、肠痉挛,给予输液、抗感染治疗无效。查体:腹膨隆,上腹扪及腊肠样包块,肛门指诊引出水样便、无血。3小时后排果酱样血便。手术证实为肠套叠。 误诊原因分析:与成人相比,新生儿食管相对较长,胃贲门较大,胃入口括约肌不发达,幽门括约肌发育良好,故较易发生溢乳及呕吐。故肠套叠后易误诊为消化系统疾病。本文2例误诊亦与患儿临床表现不典型及基层医院对小儿外科疾病诊治经验不足有关。
Example 1: 20 days after birth. Because of lethargy for a long time, woke up crying, refusing milk, pale, sweating admission. Physical examination showed no abnormalities, abdominal X-ray showed no level. Suspected hypoglycemia, given hypertonic sugar, vitamin C and other intravenous injection, still lethargy. 4 hours after admission, repeated vomiting, severe crying, re-examination of the left quarter ribs palpable like sausage-like mass, 1 hour after the row of jam-like bloody stools, diagnosis of intussusception, surgical treatment. Example 2: 26 days after birth. Vomiting and diarrhea, bursts of crying for 1 day, drainage day will be more than 10 times, to be diagnosed as enteritis, intestinal spasms, given infusion, anti-infective therapy is invalid. Physical examination: Abdominal bulge, abdomen palpable mass of sausage, anal fingering leads to watery stools, no blood. 3 hours after the discharge of jam-like blood. Surgical confirmation of intussusception. Misdiagnosis analysis: Compared with adults, neonatal esophageal relatively long gastric cardia greater gastric portal sphincter underdeveloped, pyloric sphincter developed well, it is more prone to galactorrhea and vomiting. Therefore intussusception easily misdiagnosed as digestive diseases. Two cases of misdiagnosis also with the clinical manifestations of children with atypical hospital and primary hospital pediatric surgical diagnosis and treatment of diseases related to lack of experience.