儿童良性气腹的诊断及治疗

Diagnosis and Treatment of Benign Pneumoperitoneum in Children

摘要: 气腹是指腹膜腔内出现游离气体。大约90%的气腹是由于腹腔内空腔脏器穿孔形成，多伴有腹膜炎等感染症状，常需急诊行手术探查诊断及治疗，这种类型的气腹称为外科气腹；但仍有约10%的气腹形成与腹腔内脏器穿孔无明确关联，患儿无明显感染中毒症状，常可采用保守治疗的方式，称为良性气腹或非外科气腹。然而良性气腹发生原因复杂，早期诊断困难，不同年龄段的及不同原因的儿童气腹评估标准不同，临床上可能发生非必要手术。故判断气腹是否为良性气腹，是否需行手术，是外科医生在诊断及选择治疗方式过程中的难题。本文将对既往针对儿童气腹诊断及治疗的文献进行回顾总结，探讨儿童气腹的诊断及治疗方式的选择问题。

Abstract: Pneumoperitoneum refers to the presence of free air in the peritoneal cavity. About 90% of children’s pneumoperitoneum accompanied by peritonitis and other infectious symptoms is due to the perforation of abdominal hollow viscus, and emergency surgical operation is often required. This type of pneumoperitoneum is called surgical pneumoperitoneum; however, about 10% of the pneumoperitoneum is not clearly associated with the perforation of the abdominal organs, and the patients who have no obvious symptoms of infection and can often be treated conservatively, are diagnosed benign pneumoperitoneum or non-surgical pneumoperitoneum. The etiologies of benign pneumoperitoneum remain complicated, the early diagnosis is difficult. Children with pneumoperitoneum of different ages and for various reasons have different criteria for assessing treatment, so the non-essential surgery may occur clinically. Therefore, it is still considered a clinical dilemma for surgeons to estimate whether the pneumoperitoneum is benign or whether the surgical intervention is required. In this paper, we will review and summarize the previous works of literature on the diagnosis and treatment of children’s pneumoperitoneum, and discuss the diagnosis and treatment.