原发性腹茧症16例的诊断与外科治疗  

Diagnosis and surgical treatment of abdominal cocoon ：a report of 16 cases

作　　者：胡伟明[1] 韩方海[1] 张肇达[1] 周祥[1] 贾巍[1] 陆慧敏[1] 

机构地区：[1]四川大学华西医院普通外科,成都610041

出　　处：《中华胃肠外科杂志》2007年第3期261-264,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的提高对腹茧症的术前诊断率，进行合理的外科治疗。方法分析1993年6月至2006年10月四川大学华西医院普通外科收治的16例腹茧症患者的临床资料。结果术前8例经钡剂造影显示受累小肠管形成“扭麻花”状；钡柱前端前进方向呈“M”形；6例显示为不完全性小肠梗阻：2例肠管排空时间延长。CT检查显示肠管扩张、其周围可见一层膜状物。手术中均发现全部或部分小肠被一层灰白色致密坚韧的纤维膜包裹，其中包裹部分小肠（I型）1例；包裹全部小肠（Ⅱ型）2例；包裹全部小肠及其他脏器（Ⅲ型）12例。全组行粘连松解术，2例行小肠排列术．1例慢性幽门梗阻患者行胃造口术。1例在剥离、切除包裹膜的同时行直肠癌根治术，合并回肠克罗恩病的患者同时进行部分回肠结肠吻合术，但术后10d再次出现小肠瘘，予以保守治疗而愈。全部治愈出院。病理诊断均为小肠浆膜面纤维结缔组织。结论腹茧症术前诊断主要依靠钡剂造影和CT．手术应彻底切除包膜、松解粘连及预防小肠梗阻。Objective To explore the diagnosis and surgical treatment of abdominal cocoon. Methods The clinical data of 16 patients with abdominal cocoon admitted to our hospital between Jun. 1993 and Oct. 2006 were analyzed retrospectively. Results Preoperatively, Barium meal X-rays revealed coils of intestine in 8 cases, incomplete intestinal obstruction in 6 cases, and prolonged intestinal transit time in 2 cases. CT scan showed dilated intestine and intestinal loops seemed to be encapsulated in a thickened capsule. After opening the peritonium, entire or partial intestine encapsulated in thickened membrane encasing were found, including partial intestine encapsuled in 1 cases （Type Ⅰ ）, entire intestine encapsuled in 2 cases （Type Ⅱ ）, and entire intestine and other organs encapsuled in 12 cases（Typem ）. All the cases underwent adhesiolysis. Intestinal splint was done in 2 patients, gastrostomy in one patient with chronic pyloric obstruction, radical resection of rectal cancer in one patients and iliocolic resection in one patients with Crohn＇s disease. All patients were healed by surgical operation and confirmed the diagnosis histopathologically. Conclusions Abdominal cocoon is rare. It is difficult to make a right diagnosis preoperatively. Barium meal X-rays and CT scan are useful methods for its diagnosis. For the treatment, attention should be paid on complete resection of fibrous membrane, adhesiolysis and prevent intesinal obstruction.

关 键 词：腹膜疾病 腹茧症 诊断 外科手术 

分 类 号：R656[医药卫生—外科学]