先天性十二指肠梗阻的X线诊断(附85例分析)

X - ray diagnosis of congenital duodenal obstruction

目的 探讨婴幼儿十二指肠梗阻的X线诊断及鉴别诊断。方法 回顾性分析了我院1996年1月至2000年12月间85例资料完整的十二指肠梗阻病例,每例均进行了腹平片检查,80例作了上消化道造影检查,48例作了钡灌肠辅助检查。结果 85例腹部平片显示“双泡征”46例,“单泡征”27例,“三泡征”7例。小肠未见充气29例,小肠充气减少47例,充气肠管正常9例。80例上消化道造影25例显示十二指肠完全梗阻,46例为十二指肠不完全梗阻,同时发现中肠扭转16例;未见梗阻9例。手术证实肠旋转不良46例;先天性十二指肠狭窄或闭锁(包括膜式闭锁)24例,环状胰腺15例。结论 腹部平片检查大部分能够作出十二指肠梗阻的诊断,3种疾病的鉴别要做上消化道造影检查,必要时辅以钡灌肠检查。

X - ray diagnosis and differential diagnosis of congenital duodenal obstruction in infants were discussed. Methods The clinical records and imaging findings of 85 children and infants in our hospital from Jan 1996 to Dec 2000 with duodenal obstruction were reviewed retrospectively. Abdominal plain films of all patients were obtained, UGI series were performed in 80 patients , and barium enemas were performed in 48. Results 46 cases with double - bulb, 27 with single - bulb, 7 with tri - bulb, 29 absend of air in the intestines, 47 with less air in the intestines and 9 patients with normal gaseous patterns were found on the plain films. 25 patients with completive obstruction, 46 with partial obstruction (including 16 cases were associated with midgut volvulus) and 9 cases without obstruction were found in UGI series. Surgical operation confirmed that 46 cases with malrotation of intestines, 24 with congenital duodenal atresia or stenosis (including membranous stenosis) and 15 with annular pancreas. Conclusion Most cases of duodenal obstruction can be diagnosed with plain films. Differential diagnosis of these three diseases can be achieved by UGI series, and sometimes the barium enema is needed if extra assistance.