原发性网膜梗死17例临床分析  

Clinical analysis of 17 cases of primary omental infarction in children

作　　者：尹福瑞 万钧[1] 王继忠[1] Yin Furui;Wan Jun;Wang Jizhong(Department of Emergency Surgery,Tianjin Children’s Hospital,Tianjin 300134,China)

机构地区：[1]天津市儿童医院急创外科,天津300134

出　　处：《临床小儿外科杂志》2025年第3期260-264,共5页Journal of Clinical Pediatric Surgery

基　　金：天津市医学重点学科(专科)建设项目资助(TJYXZDXK—040A)。

摘　　要：目的总结儿童原发性网膜梗死的临床特点、诊断及治疗方法。方法回顾性分析2017年6月至2022年6月天津市儿童医院收治的17例原发性网膜梗死患儿临床资料,男14例、女3例,年龄(8.5±2.7)岁(4.9~12.8岁),对其临床表现、实验室检查、影像学、治疗及病理结果进行总结分析。结果17例体重(39.54±13.60)kg(20.8~66.9kg),白细胞(12.53±3.84)×10^(9)/L(6.34×10^(9)/L~21.26×10^(9)/L),中性粒细胞百分比66.7%(60.1%~73.7%),C反应蛋白(23.71±23.20)mg/L(2.50~71.10 mg/L)。17例均以腹痛为主要症状,从发病到就诊的时间为48(24,72)h。腹部压痛部位:右下腹7例,右上腹2例,右腹2例,脐周2例,上腹2例,左下腹1例,全腹1例。17例均行超声检查,其中11例显示高回声区;3例表现为肠腔低回声区,周围高回声区;2例因腹壁厚未探及肿块;1例示右下腹炎性肿块。12例行腹部平扫CT,其中9例显示网膜区局部脂肪密度增加,1例显示条纹状高密度影,2例显示肠系膜脂肪密度增加。1例行腹部平扫及增强CT,平扫CT显示椭圆形低密度病变,增强CT显示为低密度肿块并伴有轻度强化。17例均行腹腔镜部分大网膜切除术。术后病理结果:11例网膜扭转伴坏死,6例网膜坏死。结论儿童原发性网膜梗死是引起急性腹痛的一种罕见病,腹痛大多位于右下腹部,持续时间2~3天,不伴消化道症状及发热;超声和CT在诊断中起到重要作用,腹腔镜手术可切除病灶并缓解症状。Objective To summarize the clinical characteristics,diagnosis,and treatment of primary omental infarction in children.Methods A retrospective analysis was conducted on 17 pediatric cases of primary omental infarction treated at Tianjin Children’s Hospital from June 2017 to June 2022.The cohort included 14 males and 3 females,with a mean age of 8.5±2.7 years(range:4.9-12.8 years).Clinical presentations,laboratory findings,imaging results,treatments,and pathological outcomes were analyzed.Results The mean weight of the children was 39.54±13.60 kg(range:20.8-66.9kg).Laboratory results showed a mean white blood cell(WBC)count of 12.53±3.84×10^(9)/L(range:6.34×10^(9)/L-21.26×10^(9)/L),a neutrophil percentage(NEUT%)of 66.7%(range:60.1%-73.7%),and a mean C-reactive protein(CRP)of 23.71±23.20 mg/L(range:2.50mg/L-71.10 mg/L).All 17 cases presented with abdominal pain as the primary symptom,with a median time from onset to hospital visit of 48 hours(range:24-72 hours).The locations of abdominal tenderness included the right lower quadrant(7 cases),right upper quadrant(2 cases),right abdomen(2 cases),periumbilical region(2 cases),upper abdomen(2 cases),left lower quadrant(1 case),and whole abdomen(1 case).Ultrasound examination was performed in all cases,revealing high-echo areas in 11 cases;low-echo areas in the intestinal lumen surrounded by high-echo regions in 3 cases;no detectable masses due to thick abdominal walls in 2 cases;and an inflammatory mass in the right lower quadrant in 1 case.Abdominal CT was performed in 12 cases,showing increased fat density in the omental region in 9 cases,striated hyperdense areas in 1 case,and increased mesenteric fat density in 2 cases.One case underwent plain and contrast-enhanced abdominal CT,which revealed an oval hypodense lesion with mild enhancement.All 17 cases underwent laparoscopic partial omentectomy.Histopathological findings revealed omental torsion and omental infarction in 11 cases,omental infarction in 6 cases.Conclusions Primary omental infarction is a rare c

关 键 词：梗死 腹膜腔 外科手术 儿童 

分 类 号：R72[医药卫生—儿科]