儿童乙状结肠扭转的诊治分析  

Diagnoses and managements of sigmoid volvulus in children

作　　者：宋虎伟 刘涛 周祥 贾新建[1] 魏强[1] Song Huwei;Liu Tao;Zhou Xiang;Jia Xinjian;Wei Qiang(Department of General Surgery,Xi'an Children's Hospital,Xi'an 710003,China)

机构地区：[1]西安市儿童医院普外科,西安710003

出　　处：《中华小儿外科杂志》2024年第11期1014-1017,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨儿童乙状结肠扭转(sigmoid volvulus, SV)的临床特点。方法回顾性分析2018年1月至2023年1月西安市儿童医院收治的5例乙状结肠扭转患儿的临床资料, 所有患儿均为男患儿, 中位年龄为12岁4个月, 年龄范围为5岁8个月至15岁1个月。通过腹部X线片、CT以及B型超声检查确诊, 给予禁饮食、胃肠减压等对症治疗, 4例行剖腹探查, 1例行腹腔镜探查转为开腹, 其中3例行单纯复位+肠壁组织活检;2例行乙状结肠部分切除+结肠造瘘术, 于术后3个月行瘘闭合术。术后随访3~57个月。结果腹痛、腹胀、呕吐为SV的主要临床表现。3例既往有便秘病史, 1例既往有肠梗阻病史。4例腹部X线片有"咖啡豆征", 2例腹部CT检查显示"漩涡征"。3例患儿有乙状结肠冗长。5例病理检查结果均提示有神经节细胞。随访1例偶有腹痛, 1例单纯复位后出现复发再手术。结论腹部X线片"咖啡豆征"及腹部CT"漩涡征"对SV具有重要的诊断意义。儿童SV罕见且多见于男患儿, 对于急腹症既往有长期便秘病史的患儿需警惕SV可能。Objective:To explore the clinical features and treatments of pediatric sigmoid volvulus(SV).Methods:From January 2018 to January 2023,retrospective analysis was conducted for the relevant clinical data of 5 SV boys with a median age of 12.3(5.6-15)years.A definite diagnosis was made by abdominal radiography,contrast tomography(CT)scan and ultrasonography.Symptomatic measures of dietary restrictions and gastrointestinal decompression were offered.Laparotomy(n=4)and conversion from laparoscopy into laparotomy(n=1)were initially performed.Then simple detorsion and intestinal wall biopsy(n=3)and partial resection of sigmoid and colostomy and fistula closure(n=2)were performed at Month 3 post-operation.Postoperative follow-up period was(3-57)month.Results:Abdominal pain,abdominal distension and vomiting are the major clinical presentations.There was a previous history of constipation(n=3)and intestinal obstruction(n=1).A sign of"coffee bean"was evident on abdominal radiograph(n=4).And"whirl sign"appeared on abdominal computed tomography(CT,n=2).There were redundant distended sigmoid(n=3)and ganglion cells in intestinal wall(n=5).During follow-ups,1 child had occasional abdominal pain.Reoperation occurred after simple reduction(n=1).Conclusion:Abdominal radiographic"coffee bean sign"and abdominal CT"swirl sign"have important diagnostic significance.Extremely rare in children,SV is more common in boys.For individuals of acute abdomen with a previous history of habitual constipation,SV should be suspected.

关 键 词：乙状结肠疾病 咖啡豆征 儿童 

分 类 号：R726.5[医药卫生—儿科]