非新生儿肠旋转不良的诊断和治疗
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陈晋湘 E-mail:skybaien@sina.com

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Diagnosis and treatment of intestinal malrotation in non-neonatal patients
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    摘要:

    目的:探讨非新生儿肠旋转不良的诊断及治疗要点。
    方法:回顾性分析11例非新生儿肠旋转不良患者的临床资料。
    结果:非新生儿肠旋转不良以呕吐及阵发性腹痛为主要临床表现,症状不典型。11例中消化道造影确诊6例,消化道钡餐造影结合B超检查确诊2例,消化道钡餐造影结合CT检查确诊1例,术前确诊率82%。所有患者均接受Ladd手术治疗,1例术后发生肠粘连,经保守治疗后好转,其余患者恢复良好。均获随访6~60个月,除1例1年后发生肠梗阻,治疗后缓解,余患者情况良好。
    结论:反复呕吐、腹痛的非新生儿患者应警惕肠旋转不良的可能。结合多种影像学检查可提高非新生儿肠旋转不良诊断率。Ladd手术是安全可靠的方法。

    Abstract:

    Objective:To investigate the diagnosis and treatment of intestinal malrotation in non-neonatal patients.
    Methods:The clinical data of 11 non-neonatal patients with intestinal malrotation were analyzed retrospectively.
    Results:Patients presented with vomiting and paroxysmal abdominal pain as the main clinical manifestations. There were no typical symptoms and signs of intestinal malrotation in non-neonatal patients. A diagnosis of intestinal malrotation was made preoperatively in 6 patients by  gastrointestinal contrast study, 2 patients by barium meal and ultrasonography and one patient by barium meal and computerized tomography. The preoperative diagnosis rate was 82%. All patients were proven to have intestinal malrotation intraoperatively and underwent a Ladd procedure. Only one patient had postoperative complication of adhesion of intestine, and recovered after conservative treatment. The others recovered well. All the patients received follow-up of 6-60 months and were asymptomatic, except one case of intestinal obstruction that occurred one year later and recovered by non-operative treatment.
    Conclusions:The possibility of intestinal malrotation should be suspected in non-neonatal patients with symptoms of recurrent vomiting and abdominal pain. Combining various imaging assays can enhance the diagnosis rate of intestinal malrotation. Ladd procedure is a safe and reliable treatment of intestinal malrotation with low rates of complications.

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胡斌|陈子华|陈志康|伍绍斌|葛杰|陈晋湘.非新生儿肠旋转不良的诊断和治疗[J].中国普通外科杂志,2010,19(4):400-402.
DOI:10.7659/j. issn.1005-6947.2010.04.017

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  • 收稿日期:2009-11-23
  • 最后修改日期:2010-02-04
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  • 在线发布日期: 2010-04-15