本文關(guān)鍵詞：先天性腸旋轉(zhuǎn)不良的臨床診療分析　出處：《蘇州大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的本研究收集一組腸旋轉(zhuǎn)不良患者的臨床資料,分析腸旋轉(zhuǎn)不良的發(fā)病年齡、臨床表現(xiàn)、影像學(xué)特征以及術(shù)中情況,并比較不同手術(shù)方式的治療效果,以提高對先天性腸旋轉(zhuǎn)不良嚴(yán)重性的認識,期望達到改善患兒愈后、提高治愈率。資料與方法本研究收集蘇州大學(xué)附屬兒童醫(yī)院2011年1月-2015年06月4.5年間接受住院治療并在術(shù)中確診的腸旋轉(zhuǎn)不良患兒的臨床資料。研究采用回顧性分析方法,運用SPSS for windows 17.0軟件分析資料數(shù)據(jù),計量資料采用秩和檢驗,率的比較使用卡方檢驗或者Fisher確切概率法,p0.05差異有統(tǒng)計學(xué)意義。結(jié)果1.一般資料:91例先天性腸旋轉(zhuǎn)不良患兒包括男67例,女24例。其中新生兒66例,非新生兒25例。年齡分布:新生兒66例,29d-1y12例,1y-3y3例,3y以上9例。以一歲以內(nèi)最多見,約占85.7%。2.臨床表現(xiàn):嘔吐81例,其中72例膽汁性嘔吐,9例非膽汁性嘔吐。腹脹31例,腹痛8例,血便5例,3例產(chǎn)檢發(fā)現(xiàn)消化道畸形。3例因發(fā)現(xiàn)臍部腫塊而就診。3.影像學(xué)檢查:本研究中使用的影像學(xué)檢查方式包括63例腹平片、70例上消化道造影、36例鋇劑灌腸、36例腹部超聲及2例增強CT掃描。4.病理改變及合并畸形:腸旋轉(zhuǎn)不良、十二指腸Ladd膜壓迫91例,其中56例同時有腸扭轉(zhuǎn),39例有空腸上段膜狀組織粘連。術(shù)中發(fā)現(xiàn)6例患兒出現(xiàn)腸管壞死。合并畸形32例,包括先天性心臟病8例,消化系統(tǒng)畸形24例,泌尿系統(tǒng)畸形3例,臍膨出3例,21-三體綜合征2例。5.手術(shù)方式:69例行常規(guī)開腹手術(shù),22例行腹腔鏡下Ladd手術(shù)。兩組平均手術(shù)時間分別為86.51±34.87min和109.77±36.33min,平均術(shù)后住院時間為13.6±6.87d和9.90±7.75d,術(shù)后禁食時間為6.37±3.097d和3.86±1.167d。兩組數(shù)據(jù)之間的差異具均有統(tǒng)計學(xué)意義(p0.05)。6.預(yù)后:2例患兒因術(shù)中發(fā)現(xiàn)嚴(yán)重的并發(fā)癥而死亡,2例因合并21三體綜合征術(shù)后放棄治療,隨訪其最終結(jié)果為死亡。其余87例均存活,其中85例治愈,2例術(shù)后發(fā)生短腸綜合征。1例短腸綜合征患兒經(jīng)治療6月后痊愈出院,另一例經(jīng)治療8月后,仍未達到關(guān)瘺指征。結(jié)論1.先天性腸旋轉(zhuǎn)不良發(fā)病多見于一歲以內(nèi)嬰兒,尤其多見于新生兒。2.腸旋轉(zhuǎn)不良患兒可合并其他系統(tǒng)畸形,以消化系統(tǒng)畸形為最多見。3.上消化道造影是腸旋轉(zhuǎn)不良的主要檢查方式,不同影像學(xué)檢查方法的綜合應(yīng)用可提高腸旋轉(zhuǎn)不良的術(shù)前診斷率。4.腹腔鏡手術(shù)治療腸旋轉(zhuǎn)不良具有一定優(yōu)勢,可縮短患兒術(shù)后住院時間、術(shù)后禁食時間。
[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 鹵34.87min and 109.77 鹵36.33min, respectively. The average postoperative hospitalization time was 13.6 鹵6.87 days and 9.90 鹵7.75 days. The fasting time after operation was 6.37 鹵3.097d and 3.86 鹵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.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R726.5

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