新生儿肠旋转不良合并中肠扭转的诊治分析

目的总结肠旋转不良伴中肠扭转的临床特点，为早期诊治提供参考。方法2001年5月至2011年5月我们收治54例新生儿肠旋转不良伴中肠扭转患儿，分析其临床特点对及诊治经过。结果所有患儿均以胆汁性呕吐为首发症状；伴血便22例，中肠坏死7例。中肠坏死组与非中肠坏死组的肠扭转度数相比，差异有统计学意义（P=0．003）；两组出现症状至就诊的时间比较，差异无统计学意义（P=1．000）；两组出现血便至手术开始时间比较，差异有统计学意义（P=0．002）。49例cT检查见肠系膜根部漩涡征，其中15例见肠壁增厚，腹水，扭转肠管扩张积液等。54例患儿中，7例死于中肠坏死，其余47例顺利康复。结论新生儿期发生胆汁性呕吐者，应高度警惕肠旋转不良合并中肠扭转。早期诊断、及时治疗是改善患儿预后的关键。

Experience of diagnosis and treatment in intestinal malrotation with midgut volvulus in newborns

Objetive This study intends to analyze the clinical characteristics of malrotation associated with volvulus in neonates and provide help for surgeons. Methods The clinical data of 54 patients with midgut volvulus from May 2001 to May 2011 were investigated retrospectively. Results All 54 patients were found to have bile-stained vomit. Bloody stool was observed in 22 patients and midgut necrosis in 7 patients. Statistical- ly, there were significant differences between the midgut necrosis group and non midgut necrosis group in volvu- lus degree （ P = 0. 003 ） and the duration from the appearance of bloody stool to the operation （ P = 0. 002 ）. However, it was not statistically significant between the two groups in the duration from the first symptom to at- tendance（P= 1. 000）. The ＂whirlpool＂ sign on the CT scans was observed in 49 cases, of which 15 cases presented with mesenterie and bowel wall thickening ,visible aseites and distension of the midgut with air-fluid levels. Seven out of the 54 patients died of intestinal necrosis. The surviving 47 patients successfully recupera- ted. Conclusion Midgut volvulus is the most likely to occur in neonates found with abrupt onset of bile- stained vomiting. Early diagnosis and immediate operation are key factors associated with a better prognosis for these patients.