McVay Marcene R, Kokoska Evan R, Jackson Richard J, Smith Samuel D
University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 800 Marshall St, Little Rock, AR 72202, USA.
Am J Surg. 2007 Dec;194(6):712-7; discussion 718-9. doi: 10.1016/j.amjsurg.2007.08.035.
Management of typical malrotation is universally accepted, but management of atypical malrotation is less well defined in both children and adults.
Records of patients with malrotation diagnosed over 6 years were reviewed. Patients were grouped into typical or atypical based on ligament of Treitz location. Outcomes were evaluated using chi-square analysis.
Of 275 patients, 148 diagnosed with typical malrotation underwent Ladd's procedure. Based on symptoms, 91 of 127 patients with atypical malrotation were managed operatively. The remaining 36 patients were asymptomatic or had reflux symptoms only and were observed. Six of 36 subsequently required surgery due to symptoms, but 30 remain asymptomatic. No observed patients developed acute midgut volvulus. The overall postoperative complication rates were higher for atypical versus typical malrotation, 27% versus 16% (P < .05).
Close observation with repeat contrast study is an acceptable management option for patients with atypical malrotation who are asymptomatic or exhibit only reflux symptoms.
典型旋转不良的治疗已得到广泛认可，但非典型旋转不良在儿童和成人中的治疗方法尚不太明确。
回顾了6年间诊断为旋转不良患者的记录。根据Treitz韧带位置将患者分为典型或非典型。采用卡方分析评估结果。
275例患者中，148例诊断为典型旋转不良，接受了Ladd手术。根据症状，127例非典型旋转不良患者中有91例接受了手术治疗。其余36例患者无症状或仅有反流症状，予以观察。36例中有6例随后因症状需要手术，但30例仍无症状。未观察到患者发生急性中肠扭转。非典型旋转不良的总体术后并发症发生率高于典型旋转不良，分别为27%和16%（P <.05）。
对于无症状或仅有反流症状的非典型旋转不良患者，密切观察并重复造影检查是一种可接受的治疗选择。
