腹茧症的临床特点与CT诊断价值(附16例报道)  

Clinical Features and CT Diagnosis of Abdominal Cocoon: Report of 16 Cases

作　　者：阮志兵 焦俊 闵定玉 范光明 严芝强 

机构地区：[1]贵州医科大学附属医院影像科,550004 [2]贵州省人民医院病案统计室 [3]贵州医科大学附属医院胃肠外科,550004

出　　处：《临床放射学杂志》2017年第12期1825-1830,共6页Journal of Clinical Radiology

基　　金：贵阳市科技局-贵州医科大学联合基金(编号:GY2015-32)

摘　　要：目的探讨腹茧症的临床特点及影像表现,以提高腹茧症的术前诊断水平。方法回顾性分析2009年12月至2016年3月本院16例经手术、病理证实为腹茧症的临床资料与影像表现,术前均行X线立位腹部平片和CT检查,13例同时进行多期增强CT检查,5例行胃肠道钡剂造影。结果所有病例临床表现为不同程度腹痛、腹胀,伴恶心、呕吐13例,肛门停止排气排便3例,腹部包块12例,均呈反复发作、保守治疗缓解且于进食后诱发,1例13年前多次行子宫输卵管碘水造影术,6例2年前行胃肠道手术,1例行腹腔脓肿清除术,2例行胰腺假性囊肿引流术。术前影像学均提示肠梗阻,5例CT提示腹茧症。X线立位腹部平片显示肠梗阻征象但无特异性。小肠钡剂造影表现为全部或部分小肠积聚折曲,对比剂排空延迟,钡柱前端前进方向呈"M"形。CT很好地显示肠管梗阻的程度及肠管异常聚集呈"手风琴"状,能直接显示类似茧样纤维包膜包裹在成簇肠管周围,增强扫描包膜强化明显;冠状位、矢状位等多平面重组图像能更直观于显示梗阻聚集肠袢的整体形态、位置以及纤维包膜与周围结构的关系。所有病例均行剖腹探查术,行纤维包膜切除与肠粘连松解16例(100%),小肠部分切除7例,阑尾切除7例,术中发现全部(11/16)或部分(5/16)小肠被一层灰白色、透明、致密坚韧的纤维膜包裹形似"蚕茧",伴大网膜缺如3例。术后病理诊断为纤维结缔组织增生伴局部玻璃样变性、炎性细胞浸润、充血与坏死。所有病例均术后治愈出院。结论腹茧症术前诊断困难,CT表现具有一定的特征性而成为首选检查方法,手术是有效的主要处理手段。Objective To explore the clinical characteristics and imaging manifestations of abdominal cocoon,which may help in improving efficacy of early diagnosis for this disease. Methods The clinical data（ including manifestations,diagnoses,surgical and follow-up results） and imaging findings of 16 cases（ 7 males and 9 females with the age ranging from 17 to 75 years old） with abdominal cocoon confirmed by surgery and pathology from December 2009 to March 2016 were analyzed retrospectively and related literatures were reviewed. All patients underwent abdominal plain film and CT examination,including 13 cases of multi-phase enhancement CT and 1 case of gastrointestinal barium imaging. Results All16 cases with abdominal pain and abdominal distension of different degrees with no special symptoms; 13 cases of nausea and vomiting; 12 cases of abdominal masses and those which presented with repeated attacks and induced after eating. All16 cases showed intestinal obstruction before operation,including 1 case of intestine strangulation. Five cases were diagnosed as abdominal cocoon by imaging before operation. Abdominal plain X-ray showed intestinal loop dilatation and gas accumulation with multiple air-fluid levels in the small bowel without specificity. Five patients received barium meal examination demonstrated barium slowly moved through the small bowel and incomplete intestinal obstruction. Abdominal CT scan clearly showed extensive or regional incomplete obstruction of small bowel and bowel agglomeration as ＂accordion＂shape,total or partial twisty small bowel loop wrapped by thick membrane structure for all cases. The clinical symptoms and CT signs of thick membrane as cocoon with obvious enhancement and intestinal obstruction were obviously increased and aggravated during a follow-up period of 3 months to 2 years（ mean 20 months） among 6 cases of all patients. All 16 patients were cured by surgical operation（ including fiber membrane structure resection and intestinal adhesion release） and confirmed th

关 键 词：腹膜疾病 腹茧症 肠梗阻 体层摄影术 X线计算机 

分 类 号：R656[医药卫生—外科学] R816.5[医药卫生—临床医学]