92例先天性肠旋转不良不同影像学检查方法的特点

Imaging manifestations of 92 cases of congenital intestinal malrotation

目的：探讨先天性肠旋转不良不同影像学检查方法的特点。方法回顾性分析1993年1月至2012年12月本院收治、且经手术证实为先天性肠旋转不良的92例患儿的临床资料。以手术结果为金标准，分析不同影像学检查方法（腹立位片、上/下消化道造影和超声检查）的特点。结果患儿主要以呕吐、便血、腹胀以及产前超声检查异常为首发症状[分别为87.0%（80/92）、3.3%（3/92）、1.1%（1/92）和8.7%（8/92）]。68例（73.9%）无腹部阳性体征。共77例行腹立位片检查，提示肠梗阻者31例（40.3%）；36例行上消化道造影检查，33例（91.7%）检查结果与手术所见一致，其中显示肠旋转不良者14例，显示十二指肠完全梗阻或不完全梗阻者19例；22例行下消化道造影检查，均提示存在回盲部位置异常，与手术所见一致；79例行腹部超声检查，58例（73.4%）提示存在肠系膜动脉与肠系膜静脉位置关系异常（合并肠扭转39例），与手术所见一致。结论当临床怀疑本病时，可首选完善腹部超声检查，同时可选择性行腹部立位片检查，如提示有肠旋转不良及肠扭转时，需及时手术治疗；而诊断不明确时，需完善上消化道造影检查，如仍不能确诊时，可行下消化道造影检查进一步明确诊断。

Objective To investigate the imaging manifestations of congenital intestinal malrotation. Methods The clinical data of 92 infants with congenital intestinal malrotation admitted from January 1993 to December 2012 were studied retrospectively. All the 92 cases enrolled in this study were diagnosed based on imaging examinations and confirmed surgically. The imaging features of four examinations including plain abdominal radiography, upper gastrointestinal radiography, lower gastrointestinal angiography and ultrasound examination were analyzed. Results The percentage of the infants who presented with the initial clinical symptoms of vomit, blood stool and abdominal dilatation was 87.0%（80/92）, 3.3%（3/92） and 1.1%（1/92）, respectively, and eight cases [8.7%（8/92）] received prenatal ultrasound, which showed intestinal malrotation. Clinical examination showed no abdominal abnormalities in 68 （73.9%） cases. Seventy-seven cases underwent plain abdominal radiography, revealing intestinal obstruction in 31 cases. Thirty-six cases underwent upper gastrointestinal radiography, which revealed malrotation in 14 cases, and duodenal complete/incomplete obstruction or stenosis in 19 cases. Twenty-two cases underwent lower gastrointestinal angiography, and all of them were diagnosed as malrotation. Seventy-nine cases were examined with abdominal ultrasonography, and 58 cases were diagnosed as malrotation. Conclusions Rational selection of imaging examinations can improve the preoperative diagnosis. When congenital intestinal malrotation is suspected, abdominal ultrasound should be done as the first optional examination. At the same time, plain abdominal radiography should be selected accordingly. When intestinal malrotation with or without midgut volvulus is suggested, surgery should be performed as early as possible. When the diagnosis is not clear, upper or lower gastrointestinal radiography should be done.