非新生儿肠旋转不良的诊断和治疗

Diagnosis and treatment of intestinal malrotation in non-neonatal patients

目的探讨非新生儿肠旋转不良的诊断及治疗要点。方法回顾性分析11例非新生儿肠旋转不良患者的临床资料。结果非新生儿肠旋转不良以呕吐及阵发性腹痛为主要临床表现，症状不典型。11例中消化道造影确诊6例，消化道钡餐造影结合B超检查确诊2例，消化道钡餐造影结合CT检查确诊1例，术前确诊率82％。所有患者均接受Ladd手术治疗，1例术后发生肠粘连，经保守治疗后好转，其余患者恢复良好。均获随访6～60个月，除1例1年后发生肠梗阻，治疗后缓解，余患者情况良好。结论反复呕吐、腹痛的非新生儿患者应警惕肠旋转不良的可能。结合多种影像学检查可提高非新生儿肠旋转小良诊断率。Ladd手术是安全可靠的方法。

Objective To investigate the diagnosis and treatment of intestinal malrotation in non-neonatal patients. Methods The clinical data of 11 non-neonatal patients with intestinal malrotation were analyzed retrospectively. Results Patients presented with vomiting and paroxysmal abdominal pain as the main clinical manifestations. There were no typical symptoms and signs of intestinal malrotation in non-neonatal patients. A diagnosis of intestinal malrotation was made preoperatively in 6 patients by gastrointestinal contrast study, 2 patients by barium meal and uhrasonography and one patient by barium meal and computerized tomography. The preoperative diagnosis rate was 82 % . All patients were proven to have intestinal malrotation intraoperatively and underwent a Ladd procedure. Only one patient had postoperative complication of adhesion of intestine, and recovered after conservative treatment. The others recovered well. All the patients received follow-up of 6-60 months and were asymptomatic, except one case of intestinal obstruction that occurred one year later and recovered by non-operative treatment. Conclusions The possibility of intestinal malrotation should be suspected in non-neonatal patients with symptoms of recurrent vomiting and abdominal pain. Combining various imaging assays can enhance the diagnosis rate of intestinal malrotation. Ladd procedure is a safe and reliable treatment of intestinal malrotation with low rates of complications.