新生儿肠旋转不良的诊断与治疗  

Diagnosis and Treatment of Intestinal Malrotation in Neonates

作　　者：黄益民[1] 石英佐[1] 张亦鹏[1] 朱晓敏[1] 沈俊[1] 浦晓[1] 樊剑峰[1] 于忠勤[1] 徐建国[1] 

机构地区：[1]南京医科大学附属无锡第一医院小儿外科,江苏无锡214002

出　　处：《实用儿科临床杂志》2007年第23期1794-1795,共2页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨新生儿肠旋转不良的诊治及病理分型与临床表现的关系。方法对本院1990年1月-2005年12月手术治疗的肠旋转不良39例患儿进行分析。本组生后2～20d者占89．7％（35／39例），生后10d内呕吐大量草绿色胆汁者占84．6％（33／39例）。上腹可见胃形及蠕动波7例，腹膜炎及血便1例，已出现肠坏死；余患儿腹部检查无阳性体征。X线片可见“双泡征”者16例；下腹无气影、提示高位肠梗阻者7例。上消化道造影：十二指肠远端及空肠近端螺旋形下降7例，十二指肠水平段及上升段不全梗阻或空肠起始部在右上腹者5例。钡剂灌肠检查发现阑尾及回盲部位于右上腹15例、脐区5例。伴畸形12例，占30．7％。患者均行Ladd手术，术中肠扭转28例，占71.8％（28／39例）。结果治愈34例，放弃2例，死亡3例。肠闭锁1例发生吻合口瘘，术后5d出现腹膜炎，2例切口裂开，均经再次手术治愈。结论新生儿肠旋转不良多并肠扭转，对于大量草绿色胆汁样呕吐患儿，应尽早检查，钡剂灌肠造影阑尾及回盲部位置正常者亦不能排除肠旋转不良诊断，一旦确诊，应及早手术治疗。Objective To explore diagnosis, treatment, pathological typing and clinical manifestations of intestinal malrotation in neonates. Methods Surgical treatment were given to 39 cases of malrotation of the intestine from Jan. 1990 to Dec. 2005. Comprehensive analysis was carried out on clinical manifestation,flat X - ray film,upper disgestive tract film and barium meal enema radiography. Thirty -five cases were 2 -20 days after birth, accounting for 89.7%. Thirty -three cases were within 10 days after birth with large amounts of green bile vomit, accounting for 84.6%. Abdominal examinations didn＇t show positive signs in most cases. Stomach and peristaltic waves were seen in upper abdomen of 7 cases. One case had peritonitis and blood stool. Intestinal necrosis appeared. ＂Double bubble sign＂ was seen on plain X - ray film in 16 cases,and there was no air shadow in 7 cases. Upper digestive tract radiography showed distal duodenum and proximal jejunum spiral descending in 7 cases,incomplete obstruction of duodenum level and ascending sections or jejunum starting in right upper abdomen in 5 cases. Barium meal enema discovered that appendix and ileum were in right upper abdomen in 15 cases and in middle abdomen in 5 cases. Twelve cases had malformation, accounting for 30.7%. All patients underwent Ladd operation,28 cases had midintestine volvulus, accounting for 71.8% （28/39 cases）. Results Thirty -four cases were cured,2 cases were given up,3 cases died. Fistula of anastomotic stoma occured in one case of intestinal atresia occured,and the peritonitis appeared after 5 days of operation; disruption of wound occured in 2 cases of children. They were all cured by operation again. Conclusions Neonate malrotation of the intestine often complicates volvulus. Neonates vomiting with large amounts of green bile vomit shall be examined early. Normal barium meal enema and normal appendix and ileum can not exclude diagnosis of intestinal malrotatiun. Once diagnosis is confirmed,operation should be done as early as possible

关 键 词：肠旋转不良 诊断 治疗 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]