| Objective: To study the clinical data of the patients with intestinal malrotation which had surgical treatment in our hospital.and to explore the key points ofthe diagnosis and treatment of intestinal malrotation,in order to strengthen the awareness of congenital intestinal malrotation,and then improve the prognosis of malrotation,enhance the cure rate,reduce the incidence of complications.Materials and methods: The retrospective analysis was performed on patients who undergone surgical treamtment of malrotation of intestine in the Children's Hospital of Soochow University between January 2011 and June 2016.Statistics of intestinal malrotation in age of onset,clinical manifestations,imaging features,surgical approaches,and operative time,postoperative fasting time,hospitalization time,complications and prognosis,and the effects were underwent Ladd surgery and laparoscopic Ladd surgery in the treatment of congenital intestinal malrotation.Using SPSS for windows 22 software to analyze data,measurement data using rank sum test,the rate of use of the chi square test or Fisher exact probability method,P < 0.05 difference was statistically significant.Rusults: 1.General information: A total of 123 patients were included of which 85 cases of male and 38 of female,among 88 cases were newborns and 36 cases of non-newborn.Age distribution: 0-28 days 88 cases,29 days-1 years old 19 cases,1 year-5 years old 6 cases,5 years old and above 10 cases.The most common to newborns,accounting for about 71.55%.2.Clinical manifestations:there were 108 cases presented vomiting,of which 69 cases bilious vomiting and 39 cases of non-bilious vomiting.35 cases had abdominal distention.Stomachache occurred in 10 cases and bloody stool in 8 cases,jaundice were taken place in 18 cases,one case of abdominal pain with pale and other shock performance,6 cases found in digestive tract abnormalities.Another 3 cases were found in the umbilical lumps after birth 2 cases was complainted for gastroschisis.3.Imaging examination: This study used in the imaging examination,including abdominal plain film in 80 cases,upper gastrointestinal radiography in 91 cases,barium enema in 43 cases,abdominal ultrasound in 51 cases and enhanced CT scan in 10 cases.4.The pathological changes and deformity: All 123 cases with malrotation of intestinal and had duodenum Ladd membrane compression,of which 74 cases had volvulus at the same time,which 11 cases had intestinal necrosis,the remaining 51 cases did not appear intestinal torsion,and 59 cases had upper jejunum membranous tissue adhesion.Combined deformities were found in 49 cases,including congenital heart disease in 15 cases,malformation of digestive system in 24 cases,urinary system malformation in 3 cases,gastroschisis in 2 cases,omphalocele in 3 cases and trisomy 21 comprehensive syndrome in 2 cases.5.Operation methods: a total of 123 cases were given surgical treatment,the average operation time was 95.75 ± 36.2min,and the average of hospitalization time was 12.97 ± 6.77 d.Among which 93 cases underwent aparotomy procedure,and 31 patients laparoscopic,of 9 laparoscopies were intraoperatively converted into laparotomy.The mean operation times of the two groups were 87.5±34.26 min and 111.5±29.92 min.The average postoperative hospital stay was 10.31±3.5d and 8.4±2.21 d respectively.The postoperative fasting time was 4.54±1.94 d and 3.89±1.33 d.The incidence of postoperative complications was 7.14%(6/84)in the conventional group and 13.33% in the endoscopy group(4/30).The difference between the two groups was statistically significant(p <0.05).6.Prognosis: 7 cases of children due to serious complications and make their families to give up treatment,finally were confirmed dead.While,the remaining 116 cases were alive,of which 114 cases were cured,2 cases had postoperative short bowel syndrome.One case discharged after be given 6 months active treatment,another case of treatment after 1 year,still daily diarrhea dozens of times,the amount of more,went to other hospital for rehabilitation treatment.Conclusion:1.Children with malrotation often associated with other malformations,as a kind of systemic multiple malformations,while the digestive system makformation are intestinal atresia and stenosis.,and can be combined with more than two deformities2.For patients with volvulus,the surgeon should judge bowel activity strictly,resection carefully,to reduce the occurrence of short bowel syndrome.3.Laparoscopic technique is of great importance to children who are highly suspected of malrotation of the intestine,but have negative imaging findings.It can significantly shorten the postoperative hospitalization time,postoperative fasting time and reduce the incidence of postoperative complications. |
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