中肠旋转不良的CT诊断

CT diagnosis of midgut malrotation

目的探讨CT对中肠旋转不良的诊断价值。方法回顾性分析16例中肠旋转不良患者的CT检查资料。结果本组患者的CT表现特点有：（1）十二指肠水平段未达腹中线或达中线经肠系膜上动脉后方向右下方绕行；（2）回盲部异位；（3）具有环形皱壁的空肠位于右、中腹部而肠壁较光滑的回肠位于左腹部；（4）肠系膜上动脉（SMA）和肠系膜上静脉（SMV）的正常排列关系消失，且SMV以SMA为轴心顺时针或逆时针扭转；（5）肠扭转；（6）合并其他畸形。本组中肠旋转不良手术证实6例，经胃小肠钡餐检查证实6例，手术和胃小肠钡餐检查同时证实4例。结论反复腹痛就诊者首次先行CT检查时，应仔细观察十二指肠水平段走向、小肠和结肠分布及肠系膜根部周围血管的解剖位置．以排除中肠旋转不良。

Objective To explore the diagnostic value of CT in midgut malrotation. Methods The CT appearances of 16 patients with midgut malrotation were analyzed retrospectively. Results The features of CT manifestation in 16 cases were as follows： （1）Horizontal part of duodenum could not reach medioventral line or could reach it but encircled right-down behind the superior mesenteric artery （SMA）. （2）Ectopic ileocecal junction. （3）Jejunum located in right-middle abdomen while ileum in left abdomen. （4） A clockwise or counterclockwise rotation of the superior mesenteric vein （SMV） around the SMA. （5）Mid-gut volvulus. （6）Accompanied by other malformations. Conclusion Ambulation of duodenum, location of the small intestine and colon as well as anatomical position of mesenteric vessels should be intensively observed in order to exclude midgut malrotation.