新生儿肠旋转不良139例诊治经验

Experience of Diagnosis and Treatment in 139 Newborns of Malrotation

目的 总结新生儿肠旋转不良的诊治要点及手术治疗经验,以提高本病的诊治水平,改善长期预后。方法 回顾性分析2010年7月-2015年6月我院新生儿外科收治并经手术治疗的新生儿肠旋转不良139例病例资料。结果 急性发作的胆汁状呕吐及高位肠梗阻为其主要临床表现,患儿术前经腹部立位X线片、消化道造影检查、X线钡剂灌肠及腹部超声等检查考虑肠旋转不良诊断,所有患儿施行了剖腹探查术,术中证实肠旋转不良后行Ladd’S手术,发现97例（69.7%）合并中肠扭转,10例（7.2%）因伴有肠坏死而行肠切除吻合术,6例患儿因严重肠扭转肠坏死无法手术治疗,死亡率4.3%。133例治愈,治愈率95.7%,术后随访1-5年生长发育正常。结论 新生儿肠旋转不良容易合并中肠扭转是新生儿期完全性急性高位肠梗阻的主要病因之一,早期诊断、早期行手术行手术治疗,避免肠管坏死。加强围手术期处理是提高治愈率及长期生存率的关键。

Objective To summarize the experience in the diagnosis and treatment of neonatal intestinal rotation, in order to improve the level of diagnosis and treatment of the disease, improve long-term prognosis. Methods A retrospective analysis of 139 cases of neonatal surgical treatment in our hospital from July 2010 to June 2015 were collected and treated by surgical treatment.Results Its main clinical manifestations was cute onset of bile-like vomiting and high intestinal obstruction .After the diagnosis of abdominal X-ray, gastrointestinal radiography, X-ray barium enema and abdominal ultrasonography, Ladd＇ S operation was performed in 139 children with laparotomy, which was found in 97 cases （69.7%） with midgut volvulus, 10 cases （7.2%） underwent intestinal resection and anastomosis for intestinal necrosis. 133 cases were cured, the cure rate was 95.7%, postoperative follow up of 1 to 5 years of normal growth and development. 6 cases of patients were inoperable due to severe intestinal volvulus, the mortality rate was 4.3%. Conclusion Neonatal intestinal malrotation with midgut volvulus is easily one of the main causes of neonatal period of acute high intestinal obstruction, early diagnosis and surgical treatment of surgery, avoid bowel necrosis. To strengthen perioperative management is the key to improve the cure rate and long-term survival rate.