医源性肝镰状韧带缺损致内疝及获得性肠闭锁1例并文献复习  

A case of internal hernia and acquired intestinal atresia caused by hepatic falciform ligament defect and literature review

作　　者：韩国秀 耿磊[1] 刘希杰[1] 丁国建[1] 程风春[1] 傅廷亮[1] HAN Guoxiu;GENG Lei;LIU Xijie;DING Guojian;CHENG Fengchun;FU Tingliang(Department of Pediatric Surgery,Binzhou Medical University Hospital,Binzhou,Shandong,256603,China)

机构地区：[1]滨州医学院附属医院儿外科,山东滨州256603

出　　处：《当代医学》2021年第4期29-32,共4页Contemporary Medicine

基　　金：滨州医学院科技重点计划基金资助项目(BY2012KJZD02)。

摘　　要：目的探讨肝镰状韧带医源性或先天性缺损导致内疝的临床特征,以提高对该病的认识和防治水平。方法回顾性分析本院收治的1例肝镰状韧带医源性缺损致内疝并肠扭转、获得性肠闭锁患儿的临床资料;检索万方、维普、CNKI、Pubmed、Medline等数据库,截止2019年9月1日,报告的肝镰状韧带医源性或先天性缺损导致内疝的相关文献并进行分析。结果本研究病例为新生儿,因先天性消化道畸形于生后1 d在外院行手术治疗,术后即出现胆汁样呕吐,保守治疗无效,7 d后转入本院,诊断为肠梗阻,行剖腹探查,发现小肠经肝镰状韧带的医源性缺陷疝入并扭结导致肠闭锁,切除闭锁肠段行单层肠吻合术,术后恢复良好。复习文献检索39例报告,联合本院报告的1例共40例纳入分析,其中男13例,女27例,中位年龄35岁(3 d~86岁)。所有病例均表现为腹痛和呕吐。因先天性肝镰状韧带缺损导致内疝29例,医源性缺损导致内疝11例,其中腹腔镜手术后导致肝镰状韧带缺损9例。治愈38例,死亡2例。结论先天性或医源性肝镰状韧带缺损导致内疝病例罕见,但有关该病的报道逐年增多,术中发现肝镰状韧带缺损应及时修复缺损以防内疝发生。应提高对本病的认识,及早做出诊断和手术探查,以改善患者预后。Objective To explore the clinical characteristics of internal hernia caused by iatrogenic or congenital defects of the falciform ligament of the liver,in order to improve the understanding and prevention of the disease.Methods The clinical data of a child with internal hernia,intestinal volvulus,and acquired intestinal atresia caused by iatrogenic defect of the hepatic falciform ligament admitted to our hospital were retrospectively analyzed;search Wanfang,Weipu,CNKI,Pubmed,Medline and other databases,as of September 1,2019,the relevant literature of internal hernia caused by iatrogenic or congenital defect of the falciform ligament of the liver was reported and analyzed.Results The newborn in this study was treated in an outside hospital 1 day after birth due to congenital gastrointestinal malformations.Bile-like vomiting occurred after the operation.Conservative treatment was ineffective.After 7 days,he was transferred to the hospital,diagnosed as intestinal obstruction,and underwent laparotomy.It was found that the small intestine was herniated and kinked through the iatrogenic defect of the hepatic falciform ligament,resulting in intestinal atresia.The closed bowel segment was removed and a single-layer intestinal anastomosis was performed,and the postoperative recovery was good.Review the literature search 39 cases report,combined with 1 case reported by our hospital,a total of 40 cases were included in the analysis,including 13 males and 27 females with a median age of 35 years(3 days to 86 years).All cases showed abdominal pain and vomiting.There were 29 cases of internal hernia due to congenital hepatic falciform ligament defect,11 cases of internal hernia caused by iatrogenic defect,and 9 cases of liver falciform ligament defect after laparoscopic surgery.38 cases were cured,2 cases died.Conclusion Congenital or iatrogenic hepatic falciform ligament defect leads to rare cases of internal hernia,but reports about the disease are increasing year by year.The defect of hepatic falciform ligament found during

关 键 词：肝镰状韧带缺损 腹内疝 手术治疗 

分 类 号：R726.5[医药卫生—儿科]