原发性腹茧症致小肠梗阻的CT检查特征  

Computed tomography features of small intestinal obstruction caused by primary abdominal cocoon

作　　者：李斌[1] 冯联忠[1] 陈徐艰[1] 张斌忠[1] 陆忠烈[1] 沈文艳[1] 董来荣[1] 

机构地区：[1]嘉兴学院附属第二医院普通外科,浙江嘉兴314000

出　　处：《中华消化外科杂志》2016年第3期290-295,共6页Chinese Journal of Digestive Surgery

基　　金：浙江省嘉兴市科技技术局科技计划项目（2015AY23027）

摘　　要：目的总结原发性腹茧症致小肠梗阻腹部CT检查的影像学特征，探讨其诊断及鉴别诊断要点。方法采用回顾性描述性研究方法。收集2014年10月6日嘉兴学院附属第二医院收治的1例原发性腹茧症致小肠梗阻患者的临床资料，患者入院时、住院10h后行腹部CT检查。完善术前准备后急诊行剖腹探查，术后常规对症支持治疗，行病理学检查。观察腹部CT检查结果：腹部包块影像学特征、肠梗阻程度、包块内肠管情况、系膜内血管走行及其周围的纤维包膜。记录手术治疗情况、术后血常规、生化指标、凝血指标、术后恢复情况及并发症、术后病理学检查结果、随访期间患者情况。采用电话及门诊方式随访，了解患者饮食情况和有无腹痛腹胀、呕血、便血等症状；复查血常规、肝功能、肾功能、CT。随访时间截至2015年10月31日。结果入院时腹部CT检查：（1）腹部CT检查冠状位平扫：不全性肠梗阻征象，左侧腹部局部小肠肠管扩张积气，无特异性征象。（2）腹部CT检查平扫：肠管周围见增厚纤维包膜，呈包膜征；聚集成团及扩张扭曲的小肠肠管，呈香蕉状；其小肠系膜聚集、牵拉及扭转，系膜内血管走行异常。（3）腹部CT检查矢状位重建图像：纤维包膜茧样包裹聚集成团及扩张扭曲的小肠肠管形成一巨大包块，呈花瓣状，固定于腹后壁。（4）腹部CT检查冠状位重建图像：厚薄不一的纤维包膜环状包裹聚集成团及扩张的小肠，其系膜内血管走行分布异常。住院10h后复查腹部CT：（1）腹部CT检查冠状位平扫：肠梗阻征象较前明显加重，扩张肠管较前增多，扩张程度加剧。（2）腹部CT检查平扫：典型肠梗阻征象，较前加重，聚集成团、扩张水肿、积液积气的小肠肠管内有多个液平面。患者顺利行肠粘连松解＋纤维包膜切除术。术中见腹腔内有一巨大包块�Objective To summarize the computed tomography （CT） features of small intestinal obstruc- tion caused by primary abdominal cocoon and investigate the essentials of diagnosis and differential diagnosis. Methods The retrospective descriptive study was adopted. The clinical data of 1 patient with small intestinal obstruction caused by primary abdominal cocoon who was admitted to the Second Affiliated Hospital of Jiaxing University on October 6, 2014 were collected. The patient underwent abdominal CT on admission and at 10 hours after admission. The patient received emergency exploratory laparotomy after preoperative preparation, and then postoperative regular symptomatic treatment and pathological examination. Results of abdominal CT were observed, including imaging features of abdominal masses, extent of small intestinal obstruction, situation of intestinal tube within the masses, vessel distribution in the mesentery and fibrous capsules around the mesentery. Situation of operation, routine blood test, biochemical indicator, blood coagulation indexes, postoperative recovery, complications, results of pathological examination and situation of patient during follow-up were recorded. The follow-up by telephone interview and outpatient examination was applied to the patient till October 31, 2015, including detecting the dietary, with or without symptoms of abdominal pain and distension, haematemesis and hematochezia, routine blood retest, liver function, renal function and CT. Results Results of abdominal CT on admission： （1） coronal plain scan of abdominal CT showed that there were signs of incomplete intestinal obstruction, and local small intestinal dilatation and gas accumulation in left abdominal region without specific sign. （2） Plain scan of abdominal CT showed that there were the ＂coated sign＂ with thickened fibrous capsules around the intestinal tube, ＂ banana shape＂ with agglomerate and expanding-distortion intestinal tube and aggregative, stretching and twisting mesentery with abnormal

关 键 词：腹茧症 肠梗阻 体层摄影术 

分 类 号：R574.5[医药卫生—消化系统]