CAJ | 학술논문

目的探讨自闭症儿童急腹症的特点及治疗经验.方法回顾性分析2011年6月至2013年1月收治的3例自闭症儿童急腹症的临床表现,包括发病时间、起病症状、体征、辅助检查,术中情况及术后恢复情况.结果 3例患儿从发病(家属发现的客观症状)至我院就诊的时间分别为7h、3d和20余天,住院后手术的时间分别为5h、1d和2d.主诉包括呕吐、行为改变及弯腰行走,1例停止排气排便,2例出现腹泻,3例均伴发热.体格检查不配合,对疼痛不敏感,1例出现拒按腹部的行为,1例腹胀.3例血常规白细胞计数升高(10.3～17.2×109/L),以中性粒为主(69.0％～88.9％).1例腹部X线平片检查有液气平;2例腹部B型超声检查有积液,无包块.3例均行手术探查.2例行腹腔镜探查,1例中转开腹;1例剖腹探查.1例为急性阑尾炎并穿孔,1例为阑尾周围脓肿并肠梗阻,1例为梅克尔憩室化脓并穿孔.术后恢复均顺利,5～9 d出院.结论自闭症儿童发生急腹症时,主观症状,如腹痛不明显,而以客观行为为主;主诉时间与病情不符合,明显延迟;体检不合作,诊断困难,误诊率高,容易延误手术时机.一旦有手术指征立即手术,避免耽误病情,引起严重后果.及时手术治疗可取得满意疗效.
목적 탐토자폐증인동급복증적특점급치료경험.방법 회고성분석2011년6월지2013년1월수치적3례자폐증인동급복증적림상표현,포괄발병시간、기병증상、체정、보조검사,술중정황급술후회복정황.결과 3례환인종발병(가속발현적객관증상)지아원취진적시간분별위7h、3d화20여천,주원후수술적시간분별위5h、1d화2d.주소포괄구토、행위개변급만요행주,1례정지배기배편,2례출현복사,3례균반발열.체격검사불배합,대동통불민감,1례출현거안복부적행위,1례복창.3례혈상규백세포계수승고(10.3～17.2×109/L),이중성립위주(69.0％～88.9％).1례복부X선평편검사유액기평;2례복부B형초성검사유적액,무포괴.3례균행수술탐사.2례행복강경탐사,1례중전개복;1례부복탐사.1례위급성란미염병천공,1례위란미주위농종병장경조,1례위매극이게실화농병천공.술후회복균순리,5～9 d출원.결론 자폐증인동발생급복증시,주관증상,여복통불명현,이이객관행위위주;주소시간여병정불부합,명현연지;체검불합작,진단곤난,오진솔고,용역연오수술시궤.일단유수술지정립즉수술,피면탐오병정,인기엄중후과.급시수술치료가취득만의료효.
Objective To summarize the clinical characteristics and treatment experiences of acute abdomen in autistic children.Methods Retrospective analyses were performed for 3 autistic children of acute abdomen during the period of June 2011 and January 2013.The relevant clinical characteristics included disease duration,onset of symptoms,signs,accessory examinations,tentative diagnosis,intraoperative findings and postoperative recovery.Results The onset periods were 7 hours,3 days and 20 days respectively.The clinical symptoms included vomiting,behavioral changes and walking stooped.There were no flatus or constipation (n =1),diarrhea (n =2) and fever (n =3).Physical examination was non-cooperative.There were abdominal distension (n =1),abdominal muscle guarding (n =1) and resistance to abdominal pressing (n =1) because of insensitivity to pain.White blood cells were all elevated (10.3-17.2 × 109/L).Liquid-gas plane was present on X-ray in 1 case and type B ultrasound showed abdominal effusion in 2 cases.All underwent surgical exploration including 2 laparoscopic procedures.One case was intraoperatively diagnosed as acute appendicitis with perforation,was another as appendiceal abscess & intestinal obstruction and a third as Meckel's diverticulum suppuration & perforation.All recovered well after operation.Conclusions For acute abdomen in children with autism,objective behaviors are more important than subjective symptoms.There is some gap between patient conditions and complaint time.A preoperative diagnosis is often rather difficult.For avoiding delayed treatment,emergency operation is required when surgical indications arise Timely surgery may achieve satisfactory outcomes.