腹茧症再认识对诊治的启示  

Arouse of diagnose and treat on Abdominal cocoon again know

作　　者：周学付[1] 吴晖[2] 彭晓飞[1] 刘红艳[3] 何裕隆[2] 

机构地区：[1]广州医科大学附属第六医院胃肠外科,广东广州511518 [2]中山大学附属第一医院胃肠外科 [3]广州医科大学附属第六医院影像科

出　　处：《疾病监测与控制》2016年第6期446-448,共3页Journal of Diseases Monitor and Control

基　　金：广东省医学科学技术研究基金[WSTJJ2012112032010619661212203x]

摘　　要：目的通过腹茧症临床和病理特征分析,探讨提高有效诊治的策略。方法回顾分析术中诊断腹茧症16例[男11、女5例;平均年龄39岁（19～73岁）]。术前诊断急性肠梗阻10例;急性阑尾炎3例;乙状结肠癌并梗阻、腹部闭合伤并肠穿孔、右侧隐睾恶变各1例。15例腹部CT检查至少1次（增强6例,肠系膜血管重建5例）;消化道钡餐检查4例。随访3～8年。结果 16例既往均无腹腔感染或手术史,13例有慢性腹痛史。12例肠梗阻时CT检查中11例见＂肠禁锢＂征：小肠蛇形蜿蜒或呈＂菜花征＂;非梗阻状态CT检查5例未见该征象。肠系膜上动脉重建均见系膜血管束样纠集;钡餐检查均见肠管聚集舒展受限。16例（弥漫型13例,局限型3例）中11例行全部粘连小肠松解（弥漫型10例,局限型1例）,2例同时行小肠部分切除。术后粘连松解者平均恢复时间14天（7～30天）;小肠漏1例保守治疗治愈;肠切除者1例1年后症状复发伴慢性肠瘘;余未出现肠梗阻。5仅治疗原发病的术后恢复顺利,随访情况同术前。结论腹茧症＂肠禁锢＂病理特征决定临床和影像表现;密切结合临床和影像特点是鉴别诊断的关键;解除＂肠禁锢＂是手术解除梗阻的核心。Objective To explore more effective techniques for dealing with abdominal cocoon（AC） through analysis of its clinic and pathological characteristics. Methods Clinical data of 16 patients [11 males, 5 females; average age 39y（from 19 y to 73y）] diagnosed as AC incidentally at laparotomy was analyzed retrospectively. Preoperatively, 10 were diagnosed as acute intestinal obstruction, 3 as acute appendicitis, and 3 as sigmoid colonic cancer associated with obstruction, closed abdominal injury with bowel perforation and cancer of right abdominal cryptorchidism respectively. Fifteen received abdominal CT scanning at least once（including enhanced 6; reconstruction of mesenteric arteries 5）; 4 got barium meal test of gut. All had been followed up from 3 to 8 years. Results All had no history of abdominal infection or operation but 13 had chronic abdominal pain. Among CT scanning of 12 cases at the episode of bowel obstruction, 11 showed intestine enveloped signs, ＂snake like twisting or cauliflower sign＂, but CT imaging did not displayed the signs in all 5 patients at non-obstructive state. Bundle like aggregation of mesenteric vascular was found in all 5 with superior mesenteric artery reconstruction; mass of enveloped intestine and its movement limited were detected in all 4 barium meal test. Among the 16 patients（diffuse type 13, localized type 3）, 11（diffuse type 10, localized type 1） recieved intestinal adhesion lysis completely, of which 2 received partial intestine resection simultaneously. The average recovery time of abdominal adhesion lysis was 14 days（7 to 30days）, of which one occurred intestinal leakage and cured by conservative methods, one received bowel resection had recurrence of obstruction and associated with chronic intestinal fistula one year later, and the others did not appear bowel obstruction. Patients operated without adhesion lysis recovered smoothly, and kept the same abdominal conditions as before. Conclusions The pathological feature of AC, intestine enveloped, de

关 键 词：腹茧症 肠梗阻 粘连松解 

分 类 号：R574.5[医药卫生—消化系统]