大龄儿童肠旋转不良11例诊治分析

Diagnosis and treatment of congenital intestinal malrotation in elder children

目的：探讨大龄儿童肠旋转不良的临床特点及诊治措施。方法回顾性分析2002年1月至2012年1月我们收治的11例大龄儿童肠旋转不良患儿的临床资料。结果11例患儿中，男性6例，女性5例，年龄在2～14岁，中位年龄6岁。11例大龄儿童占先天性肠旋转不良需手术治疗病例总数的5.7％（11／193）。临床表现：反复呕吐7例，腹痛6例，5例既往有反复腹痛病史。11例均行立位 X 线腹部平片检查，4例显示不同程度肠梗阻，7例无阳性表现。消化道造影检查10例，其中钡餐灌肠9例，上消化道造影（经鼻胃管注入碘水）1例，均诊断为先天性肠旋转不良。3例急腹症病例行 CT检查，其中1例平扫误诊为肠套叠；2例 CT 增强扫描确诊为先天性肠旋转不良。11例均行 Ladd’s 术，术后均恢复顺利，痊愈出院，术后随访2～4年未见再次扭转及营养不良病例。结论大龄儿童肠旋转不良临床表现不典型，主要为反复呕吐和腹痛。消化道造影是确诊的重要手段，合并急腹症时行增强CT 扫描有助于明确诊断。腹腔镜下 Ladd’s 术有望成为治疗肠旋转不良的重要方式。

Objetive To explore the clinical features,diagnosis and treatment of intestinal malrotation in elder children. Methods From January 2002 to January 201 2,the clinical data of 1 1 elder children with in-testinal malrotation were analyzed retrospectively. Results There were 6 boys and 5 girls with a median age of 6 （2 ~1 4）years.Those undergoing surgery for congenital intestinal malrotation accounted for 5.7（1 1 /1 93） percent of the total.The major clinical manifestations were vomiting （n =7）and abdominal pain （n =6）.Five cases had a previous history of recurrent abdominal pain.Abdominal plain radiography revealed varying degrees of obstruction （n =4）.Among 1 0 cases of gastrointestinal contrast examination,a definite diagnosis was made by barium enema （n =9）and iodine contrast （n =1 ）.There were 3 cases of acute abdomen.One case was misdiagnosed as intussusception by noncontrast enhanced CT scan while another 2 cases were correctly diag-nosed by contrast enhanced CT scan.And 1 1 cases of Ladd‘s surgery were discharged Uneventfully.During a follow-up period of 2 ~4 years,there was no recurrence or adverse reaction. Conclusions Clinical manifesta-tions of malrotation are non-typical in elder children.Gastrointestinal contrast is accurate for malrotation.In e-vent of acute abdomen,enhanced CT may facilitate its diagnosis.