Division of General and Thoracic Surgery, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
J Pediatr Surg. 2011 Jul;46(7):1347-52. doi: 10.1016/j.jpedsurg.2010.12.008.
Although imaging is usually used for the diagnosis of rotation abnormalities, significant false-positive and false-negative rates have been reported. We studied the utility of laparoscopy in the management of children with a suspected rotation abnormality on imaging.
The charts of all children undergoing laparoscopy for a suspected intestinal rotation abnormality from January 2000 to August 2009 were retrospectively reviewed.
There were 51 patients. Preoperative diagnosis based on upper gastrointestinal contrast study with or without contrast enema or ultrasound was malrotation without volvulus in 47%, malrotation with volvulus in 10%, and nonrotation in 6%; the other 37% had equivocal or inconclusive imaging studies. Of the patients who had a "definitive" preoperative diagnosis, 41% had a discrepant finding at laparoscopy. For those with inconclusive imaging studies, 32% were found on laparoscopy to have a narrow mesenteric base, which put them at significant risk of midgut volvulus.
Imaging studies may be inaccurate in differentiating malrotation from nonrotation or normal rotation. Laparoscopy provides an excellent opportunity to assess the base of the mesentery. Those children without a narrow-based mesentery can undergo laparoscopy alone, and those with malrotation should undergo either laparoscopic or open Ladd procedure.
尽管影像学检查通常用于诊断旋转异常，但已有大量报告显示其存在较高的假阳性和假阴性率。我们研究了影像学诊断疑似旋转异常患儿中腹腔镜的应用价值。
回顾性分析 2000 年 1 月至 2009 年 8 月期间因疑似肠旋转不良而行腹腔镜检查的所有患儿的病历资料。
共纳入 51 例患儿。术前依据上消化道造影（伴或不伴对比灌肠）或超声检查的诊断结果为无旋转合并内脏转位 47%，旋转合并内脏转位 10%，非旋转 6%；另外 37%的患儿影像学检查结果不明确或有疑问。在术前有“明确”诊断的患儿中，41%的患儿腹腔镜探查结果与术前诊断不符。对于影像学检查不明确的患儿，32%的患儿肠系膜根部较窄，存在中肠旋转不良的高风险。
影像学检查在鉴别旋转不良与非旋转或正常旋转方面可能并不准确。腹腔镜检查可提供一个极好的评估肠系膜根部的机会。对于肠系膜根部不窄的患儿，可以仅行腹腔镜检查，而对于有旋转不良的患儿，应行腹腔镜或开腹 Ladd 手术。
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