新生儿十二指肠梗阻59例X线分析

X-ray Features of Duodenal Obstruction in Neonates: An Analysis of 59 Cases

目的 探讨新生儿十二指肠梗阻的X线表现。资料与方法 回顾性分析 5 9例新生儿十二指肠梗阻的临床及X线资料 ,其中肠旋转不良 2 7例 ,十二指肠闭锁 2 2例 ,十二指肠狭窄 5例 ,环状胰腺 1例 ,肠旋转不良合并十二指肠闭锁 4例。结果 平片主要表现为单泡 (2 /5 9)、双泡 (48/5 9)、三泡 (5 /5 9)征 ,4 8例双泡征中 14例Dd/Ds(十二指肠泡直径 /胃泡直径 )≥ 1.0 ,其中完全性梗阻 13例 ,与不全性梗阻 1例有显著差异 (P <0 .0 1)。上消化道钡餐显示梗阻端形态呈圆顶状 32例 ,鸟嘴状 2例 ,束腰状 6例 ,不规则状 19例 ;14例显示空肠位置异常。钡灌肠显示盲肠位置异常 7例 (7/10 )。结论 双泡征是十二指肠梗阻最常见的X线征象 ;Dd/Ds≥ 1.0时 ,提示完全性梗阻 ;

Objective To investigate the X ray manifestations of duodenal obstruction in neonates.Materials and Methods X ray findings in 59 neonates with duodenal obstruction were retrospectively analyzed. The etiology of duodenal obstruction included intestinal malrotation (n=27), duodenal atresia (n=22), duodenal stenosis (n=5), annular pancreas (n=1) and intestinal malrotation combined with duodenal atresia (n=4). Results On plain films, the main signs were single bubble sign (n=2), double bubble sign (n=48) and tri bubble sign (n=5). In 14 of 48 cases showing double bubble sign, the ratio of duodenal bubble diameter (Dd) to stomach bubble diameter (Ds) was over 1.0. Of the 14 cases, 13 had complete obstruction and one had incomplete obstruction, and the difference in the incidence of Dd/Ds over 1.0 between the complete and incomplete obstruction cases was statistically significant (P<0.01). On upper gastrointestinal barium meal exam, the obstructed point displayed as dome shape in 32, beak shape in 2, annular shape in 6 and irregular shape in 19 cases. Malposition of the jejunum was seen in 14 cases. Abnormal cecal position on barium enema was found in 7 (7/10) cases. Conclusion Double bubble sign is most commonly seen in duodenal obstruction. Complete obstruction is strongly suggested when Dd/Ds value is over 1.0. The shape of the obstructed site is not always of help for judging the etiology of the obstruction.