新生儿原发性局部小肠扭转10例临床分析

Clinical analysis of 10 neonates with primary segmental volvulus

目的总结新生儿原发性局部小肠扭转(primary segmental volvulus,PSV)的临床特点。方法选择2014年5月至2023年5月首都儿科研究所附属儿童医院新生儿外科收治的新生儿PSV患儿进行回顾性研究,总结其临床表现、辅助检查、治疗及预后,对数据进行描述性统计分析。结果共纳入10例PSV新生儿,平均胎龄(34.1±3.0)周,出生体重(2291±646)g。8例发病日龄≤3 d,2例发病日龄>3 d,10例患儿均以腹胀为主要表现,7例伴有胆汁性呕吐,5例伴有便血。影像学检查主要提示低位肠梗阻,无特异性表现;实验室检查主要提示代谢性酸中毒及不同程度贫血。9例患儿行诊断性腹腔穿刺,穿刺液为血性5例,清亮液体2例,血性混合粪样腹水1例,乳糜性1例。10例均行急诊剖腹探查术,于术中明确诊断PSV并行小肠部分切除,同时行一期肠吻合术或肠造瘘术。10例患儿均治愈,随访至4月龄~9岁,生长发育同正常同龄儿。结论新生儿PSV是一种独立的急腹症,临床表现缺乏特异性,术前诊断困难,经过积极手术,总体预后良好。

Objective To summarize the clinical features of primary segmental volvulus(PSV)in neonates.Methods A retrospective analysis was conducted on the clinical data of neonates with PSV who were admitted to the Department of Neonatal Surgery,Children's Hospital Affiliated to Capital Institute of Pediatrics from May 2014 to May 2023.The clinical manifestations,auxiliary examinations,treatment and prognosis of the neonates were summarized,and descriptive statistical analysis was performed on the collected data.Results A total of 10 neonates with PSV were included,with a mean gestational age of(34.1±3.0)weeks and birth weight of(2291±646)g.Eight cases had an onset age of 3 d or less,and 2 cases had an onset age of more than 3 d.Abdominal distension was observed as the main manifestation in all cases,while bilious vomiting occurred in seven cases and hematochezia in five cases.Imaging examinations mainly revealed low intestinal obstruction without specific manifestations.Laboratory tests showed metabolic acidosis and varing degrees of anaemia.Nine cases underwent diagnostic abdominal puncture,of which five had bloody ascites,two had clear ascites,one had bloody mixed with fecal-like ascites,and one had chylous ascites.All the cases underwent emergency exploratory laparotomy and segmental small bowel resections with either primary intestinal anastomosis or enterostomy.All cases were successfully cured and had been followed up to the age of 4 months to 9 years with good growth and development as normal children of the same age.Conclusions Neonatal PSV is an independent abdominal emergency characterized by non-specific clinical manifestations and difficult preoperative diagnosis,but the overall prognosis is favorable after active surgical treatment.