先天性肠旋转不良96例临床分析

The clinical analysis of 96 cases of congenital intestinal malrotation

目的 :探讨先天性肠旋转不良的临床特点和诊断方法 ,以提高诊治水平。方法 :对 96例先天性肠旋转不良的临床资料进行回顾性分析。结果 :男 78例 ,女 1 8例 ,年龄 4d～ 1 7岁。新生儿期以胆汁性呕吐为特点。非新生儿期以复发性呕吐、慢性间歇性腹痛及营养不良、发育障碍为主 ,可出现便秘、腹泻、血便或黄疸等症状。影像学检查发现十二指肠梗阻、十二指肠空肠曲或空肠位置异常和盲肠位置异常等征象 ,可为早期诊断提供依据。本组均行Ladd s手术 ,1 2例绞窄性肠扭转患儿均作肠切除。其余合并症同期手术。术后痊愈 87例 ,治愈率 91例 ,5例死亡 ,4例病情恶化放弃治疗。疗效不佳的主要原因是肠扭转导致肠坏死或合并其它严重畸形。结论 :先天性肠旋转不良的临床表现缺乏特异性 ,对其认识不足 ,缺乏重视是发生误诊、漏诊的主要原因。

Objective:To investigate the clinical characteristics and diagnostic methods of congenital intestinal malrotation,promote the ability of diagnosis and treatment.Methods:The clinical data of 96 cases with congenital intestinal malrotation was studied retrospectively.Results:78 cases were boys,and 18 were girls.Their age range was 4 days to 17 years.Bilious vomiting was the characteristic clinical situation in neonatal period.Beyond the neonatal period,recurrent vomiting,chronic intermittent abdominal pain and dystrophy was the main symptom,and could be associated with constipation,diarrhea,bloody stool and jaundice.Imageology examination showed the sign of duodenum obstruction,abnormal position of duodenojejunal flexurea or jejunum and caecum,and provided a proof for early diagnosis.All the cases were treated with Ladds operation method.12 cases presented with strangulation volvulus were treated by enterectomy.The rest associated diseases weer treated with simultaneous operation.Of 96 cases,87 cases were cured after operation,and the curative rate reached 91%.5 cases died and 4 cases gave up further treatment for the complication got worse.The main reason that caused a bad effect was intestinal necrosis caused by volvulus or the associated serious malformations.Conclusions:The clinical situation of congenital interstinal malrotation is lack of specificity.The deficiency of knowledge and paying less attention to congenital intestinal malrotation is the main cause that leads to misdiagnosis and missed diagnosis.Early diagnosis and operation treatment is the key to improve the curative effect.