Rescorla F J, Shedd F J, Grosfeld J L, Vane D W, West K W
Department of Surgery, Indiana University School of Medicine, Indianapolis.
Surgery. 1990 Oct;108(4):710-5; discussion 715-6.
This report concerns 447 infants and children with anomalies of rotation and fixation. Patients were placed in four groups based on initial symptoms. Group A involved 18 patients with acute midgut volvulus. At laparotomy, midgut volvulus was noted and reduction of midgut volvulus and a Ladd procedure were performed in 10 cases and resection was required in 8. There were five deaths (28%). Group B included 54 children with chronic symptoms of intermittent volvulus or duodenal obstruction. Group C involved 44 cases of malrotation observed during exploration for other disorders. Patients in groups B and C underwent a Ladd procedure and appendectomy. There were five unrelated deaths. Group D included 331 neonates with malrotation caused by either diaphragmatic hernia (n = 111) or abdominal wall defects (n = 220). A Ladd procedure was performed on 48 patients with abdominal wall defects and 29 surviving children with diaphragmatic hernia. Only 2 of 172 (1.2%) patients with abdominal wall defects and 1 of 34 (2.9%) patients with diaphragmatic hernia not treated for malrotation had midgut volvulus. Midgut volvulus is more common in infants and is associated with a high mortality rate (28%). Patients with malrotation and chronic obstructive symptoms or those observed during other elective procedures should undergo a Ladd procedure because of the risk of midgut volvulus. The risk of midgut volvulus is low in patients with abdominal wall defects and, probably as a result of adhesions from previous neonatal operations.
本报告涉及447例存在旋转和固定异常的婴幼儿。根据初始症状将患者分为四组。A组有18例急性中肠扭转患儿。剖腹手术时发现中肠扭转，10例行中肠扭转复位及Ladd手术，8例需要切除。有5例死亡（28%）。B组包括54例有间歇性扭转或十二指肠梗阻慢性症状的儿童。C组包括在因其他疾病进行探查时发现的44例旋转不良病例。B组和C组患者接受了Ladd手术及阑尾切除术。有5例无关死亡病例。D组包括331例因膈疝（n = 111）或腹壁缺损（n = 220）导致旋转不良的新生儿。对48例腹壁缺损患者及29例存活的膈疝患儿进行了Ladd手术。未接受旋转不良治疗的172例腹壁缺损患者中只有2例（1.2%）发生中肠扭转，34例膈疝患者中有1例（2.9%）发生中肠扭转。中肠扭转在婴儿中更常见，且死亡率高（28%）。有旋转不良和慢性梗阻症状的患者或在其他择期手术中发现的患者，由于存在中肠扭转风险，应接受Ladd手术。腹壁缺损患者中肠扭转风险较低，可能是由于既往新生儿手术导致粘连的结果。
