大网膜扭转1例并文献复习  

Omental torsion： report of one case and review literatures

作　　者：葛欣[1] 王楠[1] 黄光明[1] 李景瑞[1] 于溪森[1] 陈彩玲[1] 

机构地区：[1]黑龙江省医院腹腔镜外科,黑龙江省哈尔滨市150036

出　　处：《中国基层医药》2010年第21期2894-2896,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨大网膜扭转的的诊治方法。方法回顾性分析1例并1995年1月至2009年12月部分文献报道的大网膜扭转患者73例的临床资料。结果74例患者中，男51例，女23例，男女比例为2．2：1；年龄3—65岁，平均25．3岁，其中〈18岁35例（47％，肥胖者27例），≥18岁39例（53％，肥胖者1例）。术前确诊9例（12％）；原发性大网膜扭转49例（66％），继发性大网膜扭转为25例（34％）；在原发性大网膜扭转患者中，肥胖儿童是相关危险因素；在继发性大网膜扭转患者中，粘连是最常见的病因；大网膜扭转的常见临床表现为腹痛和腹部压痛；在术前检查中，B超检查阳性率24％（6／25），CT检查阳性率96％（23／24），MRI检查阳性率100％（2／2）。治疗方式：23例采用腹腔镜手术，51例开腹手术，术中联合阑尾切除术6l例。均治愈出院，未发生大出血、肠坏死等严重并发症。结论大网膜扭转临床上不常见，术前确诊率较低，CT和MRI检查有助于做出正确的诊断；腹腔镜手术在治疗大网膜扭转中有一定的优势。Objective To study the diagnosis and treatment of omental torsion. Methods 73 patients with omental torsion from Jan 1995 to Dec 2009 in literatures together with the one we reported were reviewed and analyzed retrospectively, Results Among 74 patients ,51 cazes were male and 23 bases were female, and the ratio was 2. 2 ： 1. The range of ages was from 3 to 65 years,and the median age was 25.3 years. Among them,35 cases were less than 18 years old（47% ,and 27 with obesity） and others more than 18 years old（53% ,1 with obesity）. The accurate diagnosis before operation exsited in 9 patients. 49 patients （ 66% ） were diagnosed as primary omental torsion, and childhood obesity was the most related factor. Conversely, 25 （34%） were diagnosed as secondary omental torsion, while the most common reason was adhersion. In contrast with other clinical symotoms and signs, abdominal pain and tenderness were occurred in almost every people. Bultro sonography（ positive rate ：24% ,6/25 ） was hardly useful in diagnosis but CT （positive rate： 96%, 23/24 ） and MRI （positive rate： 100%, 2/2 ） were benificial. Operation was applied in all patients,while laparoscopy was uesed in 23 patients. As a rule,the appendix was removed together in 61 persons. The cohort of patients was recoverd fully without serious complications such as hemorrhage and intestinal infarction. Conclusion Omental torsion was a relatively rare disease,and the diagnosis should be easy with the help of CT and MRI, and the laparoscopy was the better choice for surgeons.

关 键 词：网膜 扭转 

分 类 号：R656[医药卫生—外科学]