婴儿肠旋转不良影像学检查的探讨

Role of Imaging Examination for the Diagnosis of Intestinal Malrotation in Infants

目的:探讨婴儿肠旋转不良影像学检查的价值。方法:回顾性分析41例经手术证实的婴儿肠旋转不良患者的病例资料。所有病例均摄腹部平片,16例行钡剂灌肠,18例行钡餐检查。结果:腹部平片显示十二指肠部分性梗阻32例,双泡征13例,小肠低位梗阻并腹腔积液3例,未见明显异常3例。钡剂灌肠显示阑尾位于右上腹10例,右中腹1例,左上腹4例,1例位置正常;与手术中记录的阑尾位置比较,诊断符合率较低(28.6%,4/14)。钡餐检查显示十二指肠水平段及其近端扩张、梗阻,扩张远端呈鼠尾状改变6例,其中2例显示为完全性梗阻;十二指肠空肠曲位置异常11例;十二指肠螺旋型下降13例;空肠位于右侧腹9例,位置正常1例。结论:在肠旋转不良影像学检查中,腹部平片能提供肠道气体的异常信息,可作为本病的首诊检查方法;钡剂灌肠虽然可显示阑尾位置异常,但诊断准确性低,胃肠钡餐检查可显示十二指肠的位置和形态,是确诊本病的较好影像学方法。

Objective：To evaluate the role of roentgenographic examination on the diagnosis of malrotation of intestines in infants. Methods： The radiographic materials including plain abdominal X-ray films （n=41 ）, barium enemas （n= 16） and barium meals （n=18） of 41 infants with surgically proven intestinal malrotation were collected and retrospectively analyzed. Results：On the plain abdominal X-ray films of the 41 cases, 32 cases revealed incomplete obstruction of the duodenum, 13 cases showed double bulb sign, 3 cases displayed obstruction at the lower segment of the small intestine accompanying with ascites and 3 cases looked normal. The locations of cecal appendix in the abdominal cavity demonstrated by barium enema were found as follows：in right hypochondriac region in 10 cases, right lumbar region in 1 case,left hypochondriac region in 4 cases and normal in 1 case. In comparison with the surgical findings,the diagnostic compatibility rate was as low as only 28.6% （4/14）. Barium meal showed 6 cases with dilatation of the duodenal bulb and the second as well as the third segments of the duodenum,and the distal end of dilated intestine appeared as a rat tail. In 2 of these 6 cases,complete intestinal obstruction was seen. Barium meal also demonstrated 11 other cases with abnormal location of duodeno-jejunal junction, 13 cases with a typical corkscrew appearance in the descending segment of duodenum,9 cases showing the distal jejunum located to the right of midline and 1 normal case. Conclusion： Among the 3 roentgenographic examination techniques used to diagnose intestinal malrotation,plain abdominal X-ray film was the simplest one,it offered information of abnormal gas patterns in bowels and was clinically the first optional roentgenographic examination. Although barium enema demonstrated the abnormal location of cecal appendix, yet,in comparison to surgical findings, the results were unsatisfactory. Since gastrointestinal barium meal series revealed the location and morphological features of the duodenal loop, it was a better imaging modality for diagnosing intestinal malrotation in infants.