成人回肠重复畸形的诊治体会  

Summarization of Diagnosis and Treatment of Adult Ileal Duplications

作　　者：黄欣[1] 李秉璐[1] 周皎琳[1] 肖毅[1] 赵玉沛[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院基本外科,北京100730

出　　处：《中国普外基础与临床杂志》2011年第11期1200-1204,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨成人回肠重复畸形的临床诊断和治疗方法。方法收集1996年2月至2010年12月,我院收治的6例回肠重复畸形患者的临床资料,并结合相关文献对该病的诊治方法进行分析与讨论。结果 本组6例回肠重复畸形患者均为男性,临床表现主要为消化道出血、腹痛、肠梗阻和腹部包块。其中5例行胃镜、结肠镜及腹部CT检查,3例行肠系膜动脉造影检查,均未提示消化道重复畸形;4例行99 Tcm放射性核素显像检查,其中2例提示消化道出血;3例行双气囊小肠镜检查,1例发现双回肠畸形。术前均未明确诊断,仅1例考虑回肠重复畸形可能。6例均行手术治疗,术中发现距回盲部11～100cm范围内有长度为6～25cm的重复肠管。术后病理检查证实均为回肠重复畸形,其中2例见胃黏膜异位,2例见肠腔内憩室,1例并发异位胰腺,1例伴回盲部炎性纤维性假瘤。6例患者术后均恢复良好。结论成人回肠重复畸形极为少见,临床无特异表现,目前暂无敏感性及特异性高的辅助检查,双气囊小肠镜及99 Tcm放射性核素显像有一定提示意义。术前一般很难作出明确诊断。剖腹探查时应考虑到该病的可能,一旦发现,建议手术切除。Objective To sum up the diagnosis and treatment of adult ileal duplication with clinical cases from Peking Union Medical College Hospital（PUMCH）.Methods Six cases of adult ileal duplication admitted in our hospital from February 1996 to December 2010 were analyzed.Different assistant investigations were supposed to different patients due to the chief complaints including gastroscope,colonoscopy,abdominal CT scan,arteriography,99Tcm radionuclide imaging,and double-balloon intestinal endoscope.None was made a definite diagnosis before operation with only one uncertain case.All cases received operation and pathological examination.Results All cases admitted were male.The chief complaints included intestinal bleeding,abdominalgia,intestinal obstruction,and abdominal mass.Five out of six patients received gastroscope,colonoscopy,and abdominal CT scan while three received mesenteric arteriography,but none was found any suggestion for ileal duplication.Even 99Tcm radionuclide imaging pointed out only two with abnormal abdominal bleeding.Three received double-balloon intestinal endoscope,paying attention that only one discovered with ileal duplication.In a concluding,none was made a definite diagnosis before operation with only one uncertain case.All the cases received operation.The duplications of ileum in the length of 6-25 cm were found at the site of 11-100 cm proximal to ileocecum during the operation.Pathological report confirmed the clinical diagnosis of all cases with adult ileal duplications.Two cases were found with ectopic gastric mucosa,another two with diverticulum,and one with ectopic pancreas,in addition the remaining with inflammatory fibrous pseudotumor.Prognosis were good for all after operation.Conclusions Ileal duplications are rarely seen in adults,gender prefer male.Without specific clinical symptoms and inspections,definite diagnosis before operation is hard to make.But maybe double-balloon intestinal endoscope and 99Tcm radionuclide imaging can give out positive result.Surgeons should be aware

关 键 词：消化道重复畸形 回肠重复畸形 诊断 治疗 成人 

分 类 号：R656.7[医药卫生—外科学]