胃食管反流为主要症状的先天性肠旋转不良65例诊疗经验

doi:10.3877/cma.j.issn.1674-6899.2018.02.004

中华胃食管反流病电子杂志 ›› 2018, Vol. 05 ›› Issue (02) : 61 -64. doi: 10.3877/cma.j.issn.1674-6899.2018.02.004

所属专题：经典病例；文献；

论著

胃食管反流为主要症状的先天性肠旋转不良65例诊疗经验

和军¹, 颜景灏², 姚海霞¹, 刘妍芳¹, 阿布都赛米·阿不都热依木¹, 周玲¹, 王洁¹, 李水学¹^,^†(

)

^1. 830000　乌鲁木齐，新疆维吾尔自治区人民医院小儿外科；830000　乌鲁木齐，新疆维吾尔自治区儿童医院小儿外科
^2. 830000　乌鲁木齐，新疆维吾尔自治区人民医院小儿外科；830000　乌鲁木齐，新疆维吾尔自治区儿童医院小儿外科；830000　乌鲁木齐，新疆医科大学研究生学院

收稿日期:2018-02-19 出版日期:2018-05-15
通信作者: 李水学
基金资助:
卫计委公益性行业专项(201402007)

Gastroesophageal reflux as the main symptom of congenital intestinal dysplasia 65 cases of treatment experience

Jun He¹, Jinghao Yan², Haixia Yao¹, Yanfang Liu¹, Abudoureyimu Abudousaimi·¹, Lin Zhou¹, Jie Wang¹, Shuixue Li¹^,^†()

^1. Department of Pediatric Surgery, People′s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China; Department of Pediatric Surgery, Xinjiang Uygur Autonomous Region Children′s Hospital, Urumqi 830000, China
^2. Department of Pediatric Surgery, People′s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China; Department of Pediatric Surgery, Xinjiang Uygur Autonomous Region Children′s Hospital, Urumqi 830000, China; Xinjiang Medical University Graduate School, Urumqi 830000, China

Received:2018-02-19 Published:2018-05-15
Corresponding author: Shuixue Li
About author:
Corresponding author: Li Shuixue, Email: lishuixue@sina.com

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引用本文：

和军, 颜景灏, 姚海霞, 刘妍芳, 阿布都赛米·阿不都热依木, 周玲, 王洁, 李水学. 胃食管反流为主要症状的先天性肠旋转不良65例诊疗经验[J/OL]. 中华胃食管反流病电子杂志, 2018, 05(02): 61-64.

Jun He, Jinghao Yan, Haixia Yao, Yanfang Liu, Abudoureyimu Abudousaimi·, Lin Zhou, Jie Wang, Shuixue Li. Gastroesophageal reflux as the main symptom of congenital intestinal dysplasia 65 cases of treatment experience[J/OL]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2018, 05(02): 61-64.

目的

探讨新生儿期先天性肠旋转不良的临床特征，治疗方法及预后情况。

方法

回顾性分析2008年12月至2017年12月，新疆维吾尔自治区人民医院小儿外科收治的新生儿先天性肠旋转不良65例患儿的临床资料。65例患儿手术年龄2～28 d平均手术年龄(7±1.2)d，所有患儿均通过术中或术前辅助检查证实为先天性肠旋转不良。60例出生后即出现间断性呕吐并伴胃食管反流，55例为间断性胆汁性呕吐，5例出现便血。所有患儿术前均行超声检查，阳性例数为45例。60例术前行消化道造影，阳性率92%。65例均行Ladd′s手术治疗。

结果

65例新生儿肠旋转不良患儿均术中证实先天性肠旋转不良，其中中肠扭转5例，2例有中肠扭转、中肠坏死，行肠切除肠吻合。65例患儿中合并先天性乳糜腹1例，合并其他消化道畸形20例。中肠扭转的患儿临床特点为血便、膜炎体征。

结论

间断性呕吐伴胃食管反流为先天性肠旋转不良的主要表现，血便合并腹膜炎体征是急诊手术的明确指征。消化道造影阳性率较超声更准确。新生儿期先天性肠旋转不良一经确诊早期行Ladd′s手术效果好，预后良好。

关键词: 胃食管反流, 先天性肠旋转不良, 症状

Objective

To explore the clinical features, treatment and prognosis of neonatal congenital intestinal malrotation.

Methods

From December 2008 to December 2017, 65 patients were treated for malrotation of intestine in People′s Hospital of Xinjiang Uygur Autonomous Region pediatric surgery.65 cases, of children surgical age is 2days to 28 days(the mean operative age was 7±1.2 days). All children were confirmed as congenital intestinal malrotation by intraoperative or preoperative auxiliary examination.Sixty patients developed intermittent vomiting with gastroesophageal reflux after birth.55 patients were intermittent biliary vomiting.Five patients showed hematochezia.All children underwent color Doppler examination before surgery.There were 45 cases of positive.60 patients completed digestive angiography before surgery.There were 92% of positive.Sixty-five patients underwent Ladd′s surgery.

Results

Sixty-five patients confirmed congenital intestinal malrotation during surgery.There are 5 patients with midgut torsion.2 cases had intestinal torsion and intestinal necrosis, accepted intestinal resection of intestinal anastomosis.One patient had congenital chylomicrons.Twenty patients combined with other gastrointestinal malformations.Intestinal torsion in children with clinical features are bloody stools, meningitis signs.

Conclusion

Intermittent vomiting with gastroesophageal reflux is the main manifestation of congenital intestinal malrotation.Bloody stool with peritonitis signs is a clear indication of emergency surgery.Gastrointestinal imaging is more accurate than color Doppler.Neonatal congenital intestinal malrotation complete Ladd surgery in time.Surgical effect is good, the prognosis is good.

Key words: Gastroesophageal reflux, Congenital intestinal dysplasia, Symptom

图3 术后腹部平片

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