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摘要: 目的 本研究旨在通过总结本院经手术治疗的新生儿肠旋转不良并中肠扭转的临床资料，分析该病的临床特点以及影响预后的因素，为该疾病的早期诊断提供依据并寻找影响预后不良的危险因素。方法 回顾性分析我院2012年1月—2020年12月期间经手术治疗的53例新生儿中肠扭转的患儿。根据患儿结局分为存活组和死亡组(含放弃后死亡)。比较2组临床资料(性别，日龄，发病日龄，胎龄，体重，是否合并消化道畸形，发病到手术的时间，术中所见，是否合并休克和高钾血症)的差异。连续变量的比较采用t检验分析，分类变量比较应用χ2检验分析。采用回归分析探讨影响预后的因素。结果 53例患儿中，41例存活，12例死亡，其中7例均因肠坏死家属放弃治疗后死亡。分析结果表明肠管坏死(P< 0.001)、休克(P< 0.001)、高钾血症(P=0.001)、确诊到手术的时间(P< 0.001)、二次手术(P=0.003)以及通气治疗(P< 0.001)等因素与患儿最终的死亡结局有统计学意义上的关联。不考虑后续治疗因素的影响，多元逻辑回归分析显示肠管坏死为患儿死亡结局的独立预测因子(OR＝28.1，95%CI：1.59~496.60)。结论 新生儿中肠旋转不良病死率较高，发育不良是根本原因和病理基础，呕吐和血便是主要表现，腹部立卧位X线片、消化道造影异常是早期诊断的重要线索，超声检查肠系膜上动脉、静脉位置关系可以提高诊断准确率，合并肠坏死、休克和高钾血症提示预后不良，及时发现并手术治疗有助于改善预后。Abstract: Objective This study aimed to analyze the clinical features and prognostic factors of neonatal midgut malrotation to provide a reliable clinical evidence for early diagnosis and risk factors of bad outcome.Methods Retrospective analysis was performed on 53 cases of neonatal midgut malrotation in our hospital from 2012 to 2020. The patients were divided into survival group and death group(including death after abandonment) according to the outcome of the children. Continuous variables were compared by t-test analysis, and categorical variables were compared by chi-square test analysis. Regression analysis was used to investigate the prognostic factors.Results Fifty-three children were included in the final data analysis with 41 survived. Among the 12 cases of death, 7 cases were given up due to intestinal necrosis. Intestinal necrosis(P< 0.001), shock(P< 0.001), hyperkalemia(P=0.001), time from diagnosis to operation(P< 0.001), secondary surgery(P=0.003), and ventilation(P< 0.001) were statistically associated with the outcome of death. Multivariate logistic regression analysis showed that intestinal necrosis was an independent predictor of mortality(OR＝28.1, 95%CI: 1.59-496.60) regardless of subsequent treatment.Conclusion Congenital midgut malrotation of the intestine has a high mortality rate. Dysplasia is the basic cause and pathological basis. Vomiting and bloody stools are the main manifestations. Abdominal X-radiography is an important and early clue of the illness, abnormal relationship between superior mesenteric artery and vein with ultrasound can diagnose it further, Intestinal necrosis or shock or hyperkalemia suggest poor prognosis, timely identification and surgical treatment can improve the outcome.
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Key words:
- neonatal midgut malrotation /
- diagnosis /
- prognosis /
- risk factors
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表 1 存活组和死亡组临床特点的比较
例(%)，X±S 因素 存活组(41例) 死亡组(12例) t/χ2 P 早产儿 8(19.5) 2(16.7) 0.005 1.000a) 男婴 32(78.1) 10(83.3) 0.158 1.000a) 出生体重/g 3130.9±573.7 3010.4±1009.5 0.395 0.699 围产期不良事件 10(24.4) 5(41.7) 1.365 0.243 羊水量异常 3(7.3) 1(8.3) 0.014 1.000a) 羊水污染 2(4.9) 1(8.3) 1.159 0.545a) 剖宫产 26(63.4) 4(33.3) 3.420 0.064 合并消化道畸形 8(19.5) 4(33.3) 1.012 0.314 肠管坏死 6(14.6) 9(75.0) 16.671 < 0.001 呕吐胆汁 32(78.0) 7(58.3) 1.856 0.173 呕血 4(9.8) 2(16.7) 0.442 0.608a) 发热 3(7.3) 2(16.7) 0.950 0.315a) 血便 9(22.0) 3(25.0) 0.049 1.000a) 休克 0 6(50.0) 23.117 < 0.001a) 高钾血症 1(2.4) 5(41.7) 14.229 0.001a) 起病时间(出生后)/h 135.0±249.4 185.0±410.2 -0.401 0.695 入院日龄/d 6.4±5.3 4.2±5.9 1.161 0.262 怀疑或确诊后手术时间/h 62.5±40.6 19.3±16.6 5.437 < 0.001 合并肺炎 7(17.1) 5(41.7) 3.206 0.073 二次手术 4(9.8) 6(50.0) 9.821 0.003 呼吸支持 4(9.8) 8(66.7) 17.166 < 0.001 注：a)Fisher's精确检验。 
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表 2 影响患儿预后的回归分析
临床特点 OR(95%CI) P 剖宫产 0.29(0.07~1.12) 0.073 肠管坏死 17.50(3.65~83.91) < 0.001 休克 40.0(4.08~392.75) 0.002 高钾血症 28.57(2.89~282.79) 0.004 怀疑或确诊后手术时间 0.48(0.27~0.88) 0.018 合并肺炎 3.47(0.85~14.16) 0.083 二次手术 9.25(2.00~42.77) 0.004 呼吸支持 19.50(3.80~90.05) < 0.001
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| 引用本文: |
韩代成, 夏世文, 陈样. 新生儿肠旋转不良并中肠扭转的临床诊治分析[J]. 临床急诊杂志, 2022, 23(2): 143-146. doi: 10.13201/j.issn.1009-5918.2022.02.013
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| Citation: |
HAN Daicheng, XIA Shiwen, CHEN Yang. Clinical analysis of congenital midgut malrotation of intestine[J]. J Clin Emerg, 2022, 23(2): 143-146. doi: 10.13201/j.issn.1009-5918.2022.02.013
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