婴儿结肠狭窄的临床及影像学特点

Clinical features and imaging diagnosis of colonic stenosis in infants

目的探讨婴儿结肠狭窄的临床影像特点,为诊断提供参考依据。方法收集7例原发性和继发性结肠狭窄患儿的资料,总结该病的临床特点及立位腹部平片和钡灌肠检查的表现。结果 7例患者中先天性结肠狭窄4例,临床表现为渐进性腹胀、呕吐,立位腹部平片表现为肠胀气3例、低位机械性肠梗阻1例。余3例为新生儿坏死性小肠结肠炎(NEC)回肠远端造瘘患儿。钡灌肠检查显示结肠狭窄5例,漏诊2例,此2例患儿另行小肠系造影检查,均发现升结肠近回盲部狭窄。7例均经手术证实,狭窄部位分别位于乙状结肠2例,降结肠2例,升结肠2例,横结肠1例。4例先天性结肠狭窄患儿中,2例行分期手术,其中1例随访半年,排便正常,发育良好,另1例出院后失访;另2例行回肠与结肠端端吻合术,门诊复查,腹胀缓解,发育良好。3例NEC继发结肠狭窄患儿均行分期手术,2例患儿术后2周门诊复查,随访半年,排便正常,发育良好,另1例患儿出院后失访。结论结肠狭窄的临床表现差异很大,取决于狭窄程度,NEC是继发性结肠狭窄的主要病因之一,钡灌肠检查可明确诊断。

Objective To explore clinical features and imaging diagnosis of colonic stenosis in infants. Methods Seven patients with congenital and acquired colonic stenosis proved by surgery were included in this study. The clinical features, erect abdominal plain radiograph and barium enema were analyzed. Results Of the 7 patients, 4 were congenital colonic stenosis with progressive abdominal distention and vomiting. The erect abdominal plain radiograph showed that intestinal inflation in 3 patients, low-set mechanical intestinal obstruction in 1 patient. In the remaining 3 patients who underwent ileostomy after neonatal necrotizing enterocolitis （NEC）. Barium enema showed colonic stenosis in 5 patients and 2 were missed diagnosed who underwent contrast examination in the small intestine, and which showed stenosis in ascending colon near the ileocecus. Seven patients were all proved by surgery. The stenosis sites were located in sigmoid colon in 2 cases, in descending colon in 2 cases, in ascending colon in 2 cases and in transverse colon in 1 case. In 4 cases of congenital colonic stenosis, 2 cases underwent surgical staging, 1 case was followed up for half a year, showing normal defecation and well development, the other 1 case was lost visit after hospital discharge. The other 2 cases received end-toend ileum and colon anastomosis, the abdominal distension was relieved in outpatient review, showing well-developed. Three cases with NEC and secondary colonic stenosis underwent staged surgery. Two patients were followed up in outpatient 2 weeks after operation. They were followed up for half a year, showing normal defecation and well-developed. The other 1 case was lost visit after hospital discharge. Conclusion Clinical features of colonic stenosis are very different and depend on the stenosis degree. NEC is the main cause of acquired colonic stenosis and it can be diagnosed by barium enema.