新生儿肠旋转不良70例临床分析

Clinical analysis of 70 cases of neonatal intestinal malrotation

目的探讨先天性肠旋转不良的临床特点、诊断方法及手术要点,以提高诊治水平。方法对70例新生儿先天性肠旋转不良的临床资料进行回顾性分析。结果 70例均行Ladd手术治疗,术中发现Ladd索带压迫55例,空肠上段膜状粘连36,盲肠压迫1例,肠扭转51例,肠坏死7例。伴发消化道畸形14例(20%),其中十二指肠闭锁3例,环状胰腺2例,空肠闭锁2例,异位胰腺2例,先天性短肠综合征1例,美克尔憩室1例,脐膨出1例,十二指肠异位甲状腺1例,十二指肠旁疝1例。治愈65例,治愈率92.9%。1例手术后近期症状改善不明显,因广泛肠坏死;术后放弃治疗4例。结论新生儿先天性肠旋转不良的临床表现为十二指肠不全梗阻,可反复发作,通过影像学检查大多可明确诊断。传统的Ladd术治疗效果满意,若无并发广泛肠坏死或其他严重的先天畸形,本病一般预后良好。

Objective Talking about the clinical characteristics,diagnostic methods and the focal point of the operation of congenial intestinal malrotation to improve the diagnosis and treatment of this disease. Methods To retrospective study of the clinical data of 70 cases of neonatal congenial intestinal malrotation. Results All of the 70 cases were underwent the Ladd surgery,There wre 55 cases of Ladd cable oppression,36 cases of upper jejunum membranous adhesions, 1 case of cecum oppression,51 cases of midgut volvulus and 7 cases of intestinal necrosis. 14 cases have other digestive tract malformation（20% ） ,with 3 cases of duodenal atresia,2 cases of annular pancreas,2 cases of Jejunal atresia,2 cases of heterotopic pancreas, 1 case of congenial short bowel syndrome, 1 case of Meckel＇s diverticulum, 1 case of acromphalus, 1 case of duodenal heterotopic thyroid and 1 case of paraduodenal hernia. Prognosis ： 65 cases were cured after operation, and the curative rate reached 92.9% , 1 case did not obviously improve after operation in short term, and 4 cases given up treatment. Conclusion The clinical situation of neonatal congenial intestinal malrotation is incomplete obstruction of duodenum,it may attack recurrently, and most of them can be diagnosed through imageology. If there were not complicated by gener- ally gangrene of intestine or other serious congenial malformation, traditional Ladd operation method could get favourable prognosis.