新生儿肠旋转不良70例临床分析

发布时间：2018-02-24 12:19

本文关键词： 新生儿肠旋转不良诊断外科治疗　出处：《重庆医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：探讨新生儿先天性肠旋转不良的临床特点、诊断方法及手术要点，以提高诊治水平。方法：对70例新生儿先天性肠旋转不良的临床资料进行回顾性分析。结果：70例均行Ladd手术治疗，术前明确先天性肠旋转不良诊断50例，达71.4%；20例因存在明确的肠梗阻或肠坏死表现而行剖腹探查，术中证实为先天性肠旋转不良。术中发现Ladd索带压迫55例，肠扭转51例，空肠上段膜状粘连36例，肠坏死7例，盲肠压迫1例。伴发消化道畸形14例（20%），其中十二指肠闭锁3例，环状胰腺2例，空肠闭锁2例，异位胰腺2例，先天性短肠综合征1例，美克尔憩室1例，脐膨出1例，，十二指肠异位甲状腺1例，十二指肠旁疝1例。伴发消化道外畸形7例（10%），其中房间隔缺损5例，室间隔缺损1例，肾积水1例。预后：治愈65例，治愈率92.9％，1例术后近期症状改善不明显，因广泛肠坏死，术后放弃治疗4例。结论：新生儿先天性肠旋转不良发病时间早，大多在生后1-3天发病，临床表现为十二指肠不全梗阻，可反复发作，常并发肠扭转，肠坏死发生率高，通过影像学检查大多可明确诊断。传统的Ladd术治疗效果满意，若无并发广泛肠坏死或其他严重的先天畸形，本病一般预后良好。
[Abstract]:Objective: to investigate the clinical features, diagnostic methods and operative points of congenital intestinal malrotation in neonates. Methods: the clinical data of 70 neonates with congenital intestinal malrotation were retrospectively analyzed. Results all 70 cases were treated with Ladd operation, 50 cases were diagnosed with congenital intestinal malrotation before operation, and 20 cases (71.4%) underwent laparotomy because of the presence of definite intestinal obstruction or necrosis. Ladd cord band compression was found in 55 cases, intestinal torsion in 51 cases, upper jejunum membranous adhesion in 36 cases, intestinal necrosis in 7 cases, cecum compression in 1 case, accompanied with gastrointestinal malformation in 14 cases, including duodenal atresia in 3 cases, congenital intestinal malrotation in 55 cases, intestinal torsion in 51 cases, upper jejunum membrane adhesion in 36 cases, intestinal necrosis in 7 cases, and cecum compression in 1 case. There were 2 cases of annular pancreas, 2 cases of jejunal atresia, 2 cases of ectopic pancreas, 1 case of congenital short bowel syndrome, 1 case of Meckel's diverticulum, 1 case of omphalocele and 1 case of duodenal ectopic thyroid. There were 7 cases of extradigestive tract malformation, including 5 cases of atrial septal defect, 1 case of ventricular septal defect and 1 case of hydronephrosis. Prognosis: 65 cases were cured, and the cure rate was 92.9%. 4 cases gave up treatment after operation. Conclusion: congenital intestinal malrotation occurs early in neonates, most of them occur at 1-3 days after birth. The clinical manifestations of congenital intestinal malrotation are duodenal incomplete obstruction, recurrent attacks, often accompanied by intestinal volvulus, and high incidence of intestinal necrosis. The traditional Ladd procedure is satisfactory in treatment. If there is no extensive intestinal necrosis or other serious congenital malformation, the prognosis of this disease is good.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.5

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