儿童原发性大网膜扭转的诊断与治疗  

Diagnosis and treatment of primary omental torsion in children

作　　者：陈发玲 吕志宝[1] 刘江斌[1] Chen Faling;Lv Zhibao;Liu Jiangbin(Department of General Surgery,Affiliated Shanghai Childrens Hospital,Shanghai Jiao Tong University,Shanghai200062,China)

机构地区：[1]上海市儿童医院、上海交通大学附属儿童医院普外科,上海市200062

出　　处：《临床小儿外科杂志》2018年第9期699-702,共4页Journal of Clinical Pediatric Surgery

摘　　要：目的初步探讨儿童原发性大网膜扭转的诊断方法,对治疗经验和体会进行总结。方法以2012年6月至2017年9月上海市儿童医院/上海交通大学附属儿童医院普外科收治的7例原发性大网膜扭转患儿为研究对象,收集患儿资料(包括临床表现、实验室检查、影像学检查、手术探查及术后随访资料)并进行统计分析。结果 7例患儿均为男性体重指数BMI均高于正常同龄男性儿童;发病至手术时间21～120 h,平均(64. 43±44. 00) h;患儿术前CT均发现右侧腹部低密度团块,CT值(-67～-55) HU,均为脂肪密度,团块最大直径5～8 cm,平均(6. 29±1. 11) cm;术前诊断的真阳性率为57. 14%(4/7);所有患儿均采用腹腔镜手术,其中1例因术前诊断为阑尾炎,术中探查为网膜坏死而中转开腹手术,住院时间5～8 d,平均为(6. 29±0. 95) d,术后随访5个月至5年,无1例出现并发症。结论肥胖是儿童原发性大网膜扭转发病的重要因素,CT检查对儿童原发性大网膜扭转诊断价值较高,腹腔镜手术切除坏死网膜组织为该病的首选治疗方法。Objective To explore the diagnosis and treatment of primary omental torsion in children.Methods The clinical data were retrospectively reviewed for 7 boys with primary omental torsion. Clinical manifestations,laboratory tests,imaging examinations,surgical exploration and postoperative followups were performed. Results All of the 7children were male and The values of body mass index （BMI） were higher thanthose of normal counterparts. The average operative duration was （64. 43 ± 44. 00） （21 - 120） h. Lowdensitylumps were detected preoperatively at the right side of abdomen. Computed tomography value was - 67 ～ - 55hu and average fat density （ - 61. 57 ± 5. 26） HU. The maximal diameter of mass was 5 - 8 cm with an averageof （6. 29 ± 1. 11） cm. The preoperative diagnosis was acute appendicitis （n = 3） and necrotic omental torsion（n = 4）. The correct preoperative diagnostic ratio was 57. 14% （4 / 7）. All 7 cases underwent laparoscopy. Onlyone misdiagnosed case was converted into open surgery. The average length of hospital stay was （6. 29 ± 0. 95）days. No postoperative complications occurred during a followup period of 5 months to 5 years. Conclusion Obesity is an important cause of acute primary omental torsion in children. And CT examination is an effective diagnostic method of detecting fat density mass. Laparoscopic removal of necrotic tissue is preferred.

关 键 词：原发性大网膜扭转 体重指数 腹腔镜 儿童 

分 类 号：R726.5[医药卫生—儿科]