儿童大网膜扭转的诊治进展  

Recent advances in the diagnosis and treatment of omental torsion in children

作　　者：陈佳男 季铃华 葛文亮[1] 咸华[1] Chen Jianan;Ji Linghua;Ge Wenliang;Xian Hua(Department of Pediatric Surgery,Affiliated Hospital,Nantong University,Nantong 226001,China)

机构地区：[1]南通大学附属医院小儿外科,226001

出　　处：《中华小儿外科杂志》2020年第2期187-189,共3页Chinese Journal of Pediatric Surgery

基　　金：江苏省研究生实践创新计划(SJCX19_0866);南通市社会民生科技-面上项目(MS12019001)。

摘　　要：大网膜扭转(omental torsion,OT)是一种引起儿童急性腹痛的罕见疾病,以右下腹疼痛多见,约占80%。OT可分为原发性大网膜扭转(primary omental torsion,POT)和继发性大网膜扭转(secondary omental torsion,SOT),其中又以SOT多见。POT与肥胖、解剖异常、腹腔压力突然增高等因素有关,SOT由其他疾病(如:肿瘤、疝气、囊肿等)所致。大多情况下大网膜围绕其长轴顺时针扭转,继而出现大网膜水肿、缺血、坏死等病理改变。OT无特异性症状和体征,其主要症状和体征与其他急腹症(阑尾炎、胆囊炎等)相似,所以临床上常被误诊。X线和超声对于OT诊断的敏感性和特异性不高;大网膜扭转的CT图像表现为大网膜中存在模糊的同心线性脂肪块状结构,对诊断OT具有较高的准确性。随着高质量超声、CT、CT MPR的广泛应用,通过影像学检查明确诊断OT的病例越来越多,但手术探查仍是确诊OT的重要方法。大网膜扭转治疗方法主要包括保守治疗和腹腔镜手术。对于没有出现并发症的患儿,保守治疗可达到治愈的目的,但存在复发的风险,且未证实诊断,需要较长时间的随访。对于诊断不明确或保守治疗失败的患儿,应立即腹腔镜探查。腹腔镜手术切除病变的大网膜是当前诊断和治疗OT的重要方法。As a rare cause of acute abdominal pain in children,omental torsion(OT)refers to omental twisting around a pivotal point,usually in a clockwise direction,causing omental edema,ischemia and eventual necrosis.Up to 80%of OT cases presented with right-sided abdominal pain and tenderness.It is frequently misdiagnosed in children due to similar symptoms and signs.Furthermore,radiology and ultrasound have poor sensitivity,specificity and accuracy of diagnosing.On computed tomography(CT),a whirl sign of a fatty mass with concentric linear strands in greater omentum highly hints at a diagnosis of OT.With a wider application of high-quality ultrasound,CT and CT MPR,OT is increasingly diagnosed by imaging examinations.However,operation has remained an important method for diagnosing OT.Predominant treatments include conservative medical treatment and laparoscopic surgical intervention.Laparoscopic resection of OT is vital for diagnosing and treating OT.Due to the risk of recurrence and a lack of conclusive diagnostic method,conservative treatments require extended follow-ups.If the diagnosis remains inconclusive or conservative treatments fail,laparoscopic removal surgical intervention should be performed immediately.

关 键 词：大网膜扭转 急性腹痛 大网膜 

分 类 号：R726[医药卫生—儿科]