CAJ | 학술논문

目的：分析总结先天性肠旋转不良在儿童不同年龄段的临床特点及诊治要点。方法：将我院2003年到2012年间收治的154例先天性肠旋转不良按年龄分为新生儿组（101例）和非新生儿组（53例），对临床资料进行回顾性分析，总结临床特点及诊治要点。结果：①先天性肠旋转不良多在新生儿期发病，其中以男性患儿多见，性别比例为男：女＝2．67：1。②呕吐是本病的最突出的临床症状，其特点为含大量胆汁的呕吐（89．61％）；新生儿组患儿呕吐症状出现早且严重，而部分非新生儿组（35．85％）肠旋转不良患儿在新生儿期也曾有过呕吐病史。③腹部平片、超声多普勒检查及上消化道造影对本组病例的阳性发现率分别为66．96％、76．79％和100％（P＜0．05）；超声多普勒和上消化道造影确诊肠旋转不良的确诊率分别是49．18％和65．38％（P＜0．05）；上消化道造影对新生儿组和非新生儿组肠旋转不良的确诊率分别是55．38％和82．05％（P＜0．05）。④Ladd’s手术是治疗先天性肠旋转不良的经典术式，多数病例预后好（治愈率96．08％）。结论对于生后早期反复胆汁性呕吐的患儿应考虑先天性肠旋转不良可能，尽早上消化道造影检查明确诊断，早期手术，预后多较好。
목적：분석총결선천성장선전불량재인동불동년령단적림상특점급진치요점。방법：장아원2003년도2012년간수치적154례선천성장선전불량안년령분위신생인조（101례）화비신생인조（53례），대림상자료진행회고성분석，총결림상특점급진치요점。결과：①선천성장선전불량다재신생인기발병，기중이남성환인다견，성별비례위남：녀＝2．67：1。②구토시본병적최돌출적림상증상，기특점위함대량담즙적구토（89．61％）；신생인조환인구토증상출현조차엄중，이부분비신생인조（35．85％）장선전불량환인재신생인기야증유과구토병사。③복부평편、초성다보륵검사급상소화도조영대본조병례적양성발현솔분별위66．96％、76．79％화100％（P＜0．05）；초성다보륵화상소화도조영학진장선전불량적학진솔분별시49．18％화65．38％（P＜0．05）；상소화도조영대신생인조화비신생인조장선전불량적학진솔분별시55．38％화82．05％（P＜0．05）。④Ladd’s수술시치료선천성장선전불량적경전술식，다수병례예후호（치유솔96．08％）。결론대우생후조기반복담즙성구토적환인응고필선천성장선전불량가능，진조상소화도조영검사명학진단，조기수술，예후다교호。
Objective :To analyse and conclude the clinical characteristics and the main treatment points of the congenital intestinal malrotation cases in different ages .Methods :The 154 children with congenital intestinal malrotation treated in our department from 2003 to 2012 were devided into two groups , including the neonatal group (101 cases )and non -neonatal group (53 cases) .The cases were analysed by retrospective study ,and the clinical characteristics and the main treatment points of the disease in different ages were concluded .Results ①Congenital intestinal malrotation maily appears during neonatal period , most of them were male ,and the rate of male to female was 2 .67 :1 .② Vomiting was the most prominent clinical symptom ,presenting large amounts of bilious vomiting(89 .61% );children in neonatal group vomited in early period and suffered grievous vomit ,and part of the non -neonatal group(35 .85% ) also suffered in neonatal period .③Positive detection rate in all cases were 66 .96% by Abdominal Plain Film ,76 .79% by Doppler Ultrasonography ,and 100% by Upper Gastrointestinal Contrast (P<0 .05) .The positive rates for confirmed diagnosis of congenital intestinal malrotation were 49 .18% by Doppler Ultrasonography ,and 65 .38% by Upper Gastrointestinal Contrast (P<0 .05) .The rates of diagnosis by Upper Gastrointestinal Contrast for neonatal group and non -neonatal group were 55 .38% and 82 .05% respectively(P< 0 .05) .④ Ladd’s operation is the classic operation for curing the congenital intestinal malrotation ,presenting better prognosis in most cases .(cure rate 96 .08% ) .Conclusion The possibility of congenital intestinal malrotation should be suspected in children with symptoms of recurrent bilious vomiting in early stage ,and making a definite diagnosis with the Upper Gastrointestinal Contrast as early as possible for suspecting patients ,and the prognosis is significantly better after earlier surgical treatment .