儿童哑铃型肠系膜淋巴管瘤的诊治分析  

Diagnosis and treatment of dumbbell-type mesenteric lymphangioma in children

作　　者：谢川平 严佳虞 陈亚军[1] 彭春辉[1] 庞文博[1] 张丹[1] 王增萌[1] 吴东阳[1] 王凯[1] Xie Chuanping;Yan Jiayu;Chen Yajun;Peng Chunhui;Pang Wenbo;Zhang Dan;Wang Zengmeng;Wu Dongyang;Wang Kai(Department of General Surgery,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院普通外科,北京100045

出　　处：《中华小儿外科杂志》2022年第6期484-488,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探究哑铃型肠系膜淋巴管瘤(mesenteric lymphangioma,ML)的临床特点和诊治方式。方法收集首都医科大学附属北京儿童医院2016年1月至2020年12月收治的15例哑铃型ML患儿的临床资料。其中,男11例,女4例,年龄为(4.7±2.8)岁;多以腹痛(13例)和呕吐(11例)为主要症状,术前进行腹部B型超声检查,15例均提示腹部包块,9例诊断为ML;9例完善腹部CT检查的患儿中6例诊断为ML;患病时间范围为21 h至2年。分析总结该类型ML的临床表现、诊断和治疗方法。结果15例患儿中,10例进行了急诊手术,5例选择行择期手术;其中7例进行腹腔镜囊肿切除术,3例进行腹腔镜中转开腹手术,5例进行开腹手术。术中可见15例患儿有11例合并并发症,其中9例合并肠扭转,3例合并囊内出血、感染,3例合并肠梗阻。13例患儿将肠系膜囊肿及所属肠管一并切除,切除肠管长度范围为5~50 cm;1例予肠系膜囊肿大部分切除+残余囊肿开窗引流术;1例单纯切除肠系膜囊肿。对肠扭转患儿予扭转复位后均未见肠管坏死。出院后对所有患儿随访6~54个月,未见囊肿复发。结论哑铃型ML多以急腹症就诊,常合并并发症,应尽早行手术治疗,腹腔镜手术是首选治疗方法。Objective To explore the clinical features,diagnosis and treatment of dumbbell-type mesenteric lymphangioma(ML).Methods Clinical data were retrospectively reviewed for 15 children hospitalized with dumbbell ML from January 2016 to December 2020.There were 11 boys and 4 girls with an average age of(4.7±2.8)years.Abdominal pain(n=13)and vomiting(n=11)predominated.Preoperative abdominal ultrasonography hinted at abdominal mass(n=15)and 9 cases were diagnosed as ML,And 6/9 children receiving abdominal CT examination were diagnosed as ML.The duration of illness ranged from 21 hours to 2 years.Clinical presentations,diagnosis and treatment of ML were analyzed.Results Emergency(n=10)and elective(n=5)operations were performed.There were laparoscopic cystectomy(n=7),laparoscopic conversion into laparotomy(n=3)and laparotomy(n=5).And 11 children had intraoperative complications,including volvulus(n=9),intracystic hemorrhage&infection(n=3)and intestinal obstruction(n=3).Mesenteric cysts and bowel were removed at the meantime(n=13)and the length of resected bowel ranged from 5 to 50 cm.One case underwent major resection of mesenteric cysts plus fenestration with a drainage of residual cysts.Another had a simple resection of mesenteric cysts.No intestinal necrosis occurred after torsion reduction in children with volvulus.After discharge,no cyst recurred during a follow-up period of 6 to 54 months.Conclusions Frequently associated with complications,dumbbell ML generally presents with acute abdomen.It should be operated as early as possible and laparoscopy is an ideal treatment.

关 键 词：肠系膜 淋巴管瘤 哑铃型 临床特点 治疗 

分 类 号：R735.4[医药卫生—肿瘤]