先天性肠旋转不良的临床诊疗分析

发布时间：2018-01-16 11:46

本文关键词：先天性肠旋转不良的临床诊疗分析　出处：《苏州大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的本研究收集一组肠旋转不良患者的临床资料,分析肠旋转不良的发病年龄、临床表现、影像学特征以及术中情况,并比较不同手术方式的治疗效果,以提高对先天性肠旋转不良严重性的认识,期望达到改善患儿愈后、提高治愈率。资料与方法本研究收集苏州大学附属儿童医院2011年1月-2015年06月4.5年间接受住院治疗并在术中确诊的肠旋转不良患儿的临床资料。研究采用回顾性分析方法,运用SPSS for windows 17.0软件分析资料数据,计量资料采用秩和检验,率的比较使用卡方检验或者Fisher确切概率法,p0.05差异有统计学意义。结果1.一般资料:91例先天性肠旋转不良患儿包括男67例,女24例。其中新生儿66例,非新生儿25例。年龄分布:新生儿66例,29d-1y12例,1y-3y3例,3y以上9例。以一岁以内最多见,约占85.7%。2.临床表现:呕吐81例,其中72例胆汁性呕吐,9例非胆汁性呕吐。腹胀31例,腹痛8例,血便5例,3例产检发现消化道畸形。3例因发现脐部肿块而就诊。3.影像学检查:本研究中使用的影像学检查方式包括63例腹平片、70例上消化道造影、36例钡剂灌肠、36例腹部超声及2例增强CT扫描。4.病理改变及合并畸形:肠旋转不良、十二指肠Ladd膜压迫91例,其中56例同时有肠扭转,39例有空肠上段膜状组织粘连。术中发现6例患儿出现肠管坏死。合并畸形32例,包括先天性心脏病8例,消化系统畸形24例,泌尿系统畸形3例,脐膨出3例,21-三体综合征2例。5.手术方式:69例行常规开腹手术,22例行腹腔镜下Ladd手术。两组平均手术时间分别为86.51±34.87min和109.77±36.33min,平均术后住院时间为13.6±6.87d和9.90±7.75d,术后禁食时间为6.37±3.097d和3.86±1.167d。两组数据之间的差异具均有统计学意义(p0.05)。6.预后:2例患儿因术中发现严重的并发症而死亡,2例因合并21三体综合征术后放弃治疗,随访其最终结果为死亡。其余87例均存活,其中85例治愈,2例术后发生短肠综合征。1例短肠综合征患儿经治疗6月后痊愈出院,另一例经治疗8月后,仍未达到关瘘指征。结论1.先天性肠旋转不良发病多见于一岁以内婴儿,尤其多见于新生儿。2.肠旋转不良患儿可合并其他系统畸形,以消化系统畸形为最多见。3.上消化道造影是肠旋转不良的主要检查方式,不同影像学检查方法的综合应用可提高肠旋转不良的术前诊断率。4.腹腔镜手术治疗肠旋转不良具有一定优势,可缩短患儿术后住院时间、术后禁食时间。
[Abstract]:Objective to collect the clinical data of a group of patients with intestinal malrotation, analyze the age, clinical manifestation, imaging features and intraoperative conditions of intestinal dysrotation, and compare the therapeutic effects of different surgical methods. In order to improve the understanding of the severity of congenital intestinal malrotation in order to improve the recovery of children. Data and methods this study collected the clinical data of children with intestinal malrotation admitted to hospital from January 2011 to June 2015 and diagnosed during operation in the affiliated Children's Hospital of Suzhou University. Data. Retrospective analysis was used. The SPSS for windows 17.0 software was used to analyze the data, the rank sum test was used to measure the data, and the chi-square test or Fisher exact probability method was used to compare the rates. General data of 91 children with congenital intestinal malrotation included 67 males and 24 females, including 66 newborns. 2. There were 25 cases of non-newborns. Age distribution: 66 cases with 29 d ~ (-1) y12 cases with 1y ~ (-3) y3 cases with more than 3y. The most common cases were within one year old. Clinical manifestations: 81 cases of vomiting, including 72 cases of bile vomiting 9 cases of non-bile vomiting, 31 cases of abdominal distension, 8 cases of abdominal pain and 5 cases of blood stool. 3 cases of alimentary tract malformation found by birth examination. 3. Imaging examination: the imaging methods used in this study included 63 cases of abdominal radiography and 70 cases of upper gastrointestinal angiography. 36 cases with barium enema, 36 cases with abdominal ultrasound and 2 cases with enhanced CT scanning. 4. Pathological changes and complicated malformations: intestinal rotation was poor, duodenal Ladd membrane was compressed in 91 cases, 56 of them had intestinal torsion at the same time. There were 39 cases of upper jejunum membranous tissue adhesion, 6 cases of intestinal necrosis were found during the operation. 32 cases were complicated with malformation, including 8 cases of congenital heart disease, 24 cases of digestive system malformation and 3 cases of urinary system malformation. There were 3 cases of omphalocele and 2 cases of trisomy syndrome. The mean operative time was 86.51 卤34.87min and 109.77 卤36.33min, respectively. The average postoperative hospitalization time was 13.6 卤6.87 days and 9.90 卤7.75 days. The fasting time after operation was 6.37 卤3.097d and 3.86 卤1.167d respectively. Prognosis: 2 children died as a result of severe complications found during the operation. 2 cases were given up after operation because of 21 trisomy syndrome, the final result of follow-up was death. The remaining 87 cases survived, of which 85 cases were cured. Two cases of short bowel syndrome occurred after operation. 1 case of short bowel syndrome was cured and discharged after treatment on June and the other case was treated after August. Conclusion 1. Congenital intestinal malrotation is more common in infants within one year old, especially in newborns. 2. Children with intestinal malrotation can be complicated with other system deformities. 2. The malformation of digestive system was the most common. 3. Upper gastrointestinal angiography was the main examination method of intestinal malrotation. The comprehensive application of different imaging examination methods can improve the preoperative diagnosis rate of intestinal malrotation. 4. Laparoscopic surgery has some advantages in the treatment of intestinal malrotation, can shorten the postoperative hospitalization time, postoperative fasting time.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R726.5

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