小儿非手术所致肠梗阻的病因学分析及诊断

Etiology and Diagnosis of Non-operation Caused Ileus

目的探讨小儿非手术所致肠梗阻的病因及诊断。方法回顾性分析2001年8月～2004年12月收治的非手术所致肠梗阻患儿25例,所有病例均摄腹部立位正位片,行腹部超声检查,6例行上消化道造影,7例钡灌肠造影,均接受手术治疗。结果23例获得治愈,1例死亡,1例放弃治疗。11例新生儿病例经手术证实4例为小肠闭锁,3例肠旋转不良,3例十二指肠膜状狭窄,1例胎粪性腹膜炎。8月～14岁的患儿经手术证实4例为肠重复畸形,5例美克尔憩室,2例美克尔憩室合并肠套叠,1例原发性肠套叠,2例腹茧症。结论新生儿期非手术所致肠梗阻以十二指肠隔膜狭窄或闭锁、肠闭锁或狭窄、肠旋转不良多见。婴幼儿和儿童非手术所致肠梗阻主要为美克尔憩室和肠重复畸形,原发性肠套叠早期得不到诊治也可引起肠梗阻。X线检查是诊断肠梗阻的主要手段,超声检查也具有一定的价值。

Objective To discuss the etiology and diagnosis of ileus of patients who was not operation Caused. Methods 25 patients（male：16, female：9, age：3 days to 14 years old） were treated during Aug 2001 to Dec 2004. All patients abdominal plain film and ultrasonagraphy were performed, contrast examination of upper digestive tract for 6 of them, barium enema examination for 7 children. All they were treated by using operation. Results 23 cases recovered,one case died,one case given up therapy.By the operation confirmed that there were 4 cases of small intestine atresia, 3 malrotation of intestine, 3 duodenal membraniform stenosis,one meconium peritonitis. All above 11 patients were neonates. In addition, there were 4 cases of duplication of intestine, 5 Mekel＇s diverticulum, 2 intussusception complacated with Mekel＇s diverticulum, one primary intussusception, 2 congenital small intestine adhension. Their age was from 8 months to 14 years old.Conclusions In neonatal period,the etiology of intestine obstruction non-operation reason mainly is small intestine atresia, malrotation of intestine, duodenal septum stenosis. In infants and children,the duplication of intestine and Mekel＇s diverticulum are common reason of ileus caused by nonoperation. Primary intussusception can also result in ileus if it can not be diagnosed early and treatment timely. Abdominal plain film is most valuable to diagnosis of ileus. Abdominal ultrasonagraphy also has help to some patients.