本文關鍵詞： 新生兒 腸旋轉不良 診斷 外科治療　出處：《重慶醫(yī)科大學》2012年碩士論文　論文類型：學位論文

【摘要】：目的：探討新生兒先天性腸旋轉不良的臨床特點、診斷方法及手術要點，以提高診治水平。 方法：對70例新生兒先天性腸旋轉不良的臨床資料進行回顧性分析。 結果：70例均行Ladd手術治療，術前明確先天性腸旋轉不良診斷50例，達71.4%；20例因存在明確的腸梗阻或腸壞死表現(xiàn)而行剖腹探查，術中證實為先天性腸旋轉不良。術中發(fā)現(xiàn)Ladd索帶壓迫55例，腸扭轉51例，空腸上段膜狀粘連36例，腸壞死7例，盲腸壓迫1例。伴發(fā)消化道畸形14例（20%），其中十二指腸閉鎖3例，環(huán)狀胰腺2例，空腸閉鎖2例，異位胰腺2例，先天性短腸綜合征1例，美克爾憩室1例，臍膨出1例，，十二指腸異位甲狀腺1例，十二指腸旁疝1例。伴發(fā)消化道外畸形7例（10%），其中房間隔缺損5例，室間隔缺損1例，腎積水1例。預后：治愈65例，治愈率92.9％，1例術后近期癥狀改善不明顯，因廣泛腸壞死，術后放棄治療4例。 結論：新生兒先天性腸旋轉不良發(fā)病時間早，大多在生后1-3天發(fā)病，臨床表現(xiàn)為十二指腸不全梗阻，可反復發(fā)作，常并發(fā)腸扭轉，腸壞死發(fā)生率高，通過影像學檢查大多可明確診斷。傳統(tǒng)的Ladd術治療效果滿意，若無并發(fā)廣泛腸壞死或其他嚴重的先天畸形，本病一般預后良好。
[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.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R726.5

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