腹茧症的诊断与外科治疗体会

目的：提高对腹茧症的术前诊断率,进行合理的外科治疗。方法：分析14例腹茧症患者的临床资料。结果：术前8例经钡荆造影显示受累小肠管形成“扭麻花”状,钡柱前端前进方向呈“M”形;10例显示为不完全性小肠梗阻;2例肠管排空时间延长。CT检查显示肠管扩张、其周围可见一层膜状物。手术中均发现全部或部分小肠被一层灰白色致密坚韧的纤维膜包裹。行粘连松解术,5例行小肠排列术,全部治愈出院。病理诊断均为小肠浆膜面纤维结缔组织。结论：腹茧症术前诊断主要依靠钡刑造影和CT,手术应彻底切除包膜、松解粘连及预防小肠梗阻。     

腹腔镜治疗升结肠癌合并腹茧症1例

腹茧症又称原发性硬化包裹性腹膜炎、原发性小肠禁锢症、局限性小肠外膜包裹症、小肠阶段性纤维包裹症等,以腹腔全部或部分脏器被致密灰白色的质韧纤维膜所包裹为主要特点,因其形似蚕茧而得名,女性多于男性.腹茧症分为原发性和继发性两种.原发性腹茧症患者一般由先天性腹膜缺失、发育不良引起,继发性腹茧症一般由腹部外伤、腹部手术史、腹部...     

成人腹茧症8例临床分析

目的探讨成人腹茧症临床特点及诊疗方法。方法收集1985年8月—2009年1月收治的8例成人腹茧症患者的临床资料并结合文献作一回顾性分析。结果8例中6例表现为急、慢性肠梗阻的症状;8例患者均进行了腹部X线平片检查,证实存在肠梗阻征象。2例经非手术治疗获得缓解,6例经腹腔镜及剖腹探查术中均发现全部或部分小肠被一层灰白色致密坚韧的纤维膜包裹,行粘连松解、肠排列术等,术后疗效满意。结论成人腹茧症患者术前诊断困难。消化道造影和CT检查对本病的诊断很有价值。以手术为主的综合治疗方法,多能取得满意疗效。     

腹茧症的特点及诊治方法探讨(附6例报告)

目的:探讨腹茧症的临床特点及诊治方法。方法:回顾性分析1994年3月～2005年10月收治的6例腹茧症患者的临床资料。结果:术前所有患者均行腹部X线平片,其中5例表现为不全性肠梗阻,有4例进行了上消化道碘水造影,发现全部或部分小肠积聚于某一部位。本组6例均经手术确诊并治愈,术中均发现全部或部分小肠被一层灰白色致密坚韧的纤维膜包裹。结论:腹茧症的临床表现无特异性,术前诊断困难,需手术及病理确诊。术前影像学检查对诊断本病很有价值。手术行包膜切除,肠粘连松解是治疗本病的有效方法。     

原发性腹茧症合并急性阑尾炎1例报告及文献复习

腹茧症是一种罕见的腹部疾病,病因不明,以腹腔部分或全部脏器被一层纤维包裹为其特征,包裹内容物以小肠最为常见,形似蚕茧。本病术前诊断困难,常以肠梗阻或腹部包块为首发症状,治疗原则以手术为主。对于因肠梗阻而就诊的病例,在行其他手术发现腹茧症时,原则上不作处理。我院收治原发性腹茧症合并急性阑尾炎1例,结合复习文献,报告如下。     

腹茧症的CT表现(附11例分析)

目的探讨腹茧症的CT表现,提高对腹茧症的认识和诊断水平。方法回顾分析11例经手术病理证实的腹茧症患者的临床及CT资料。结果临床表现为肠梗阻症状,其中10例腹痛,7例腹胀,4例呕吐,1例腹部包块。CT表现为肠梗阻征象。局部肠管扩张、盘曲,被明显强化的纤维膜包裹或分隔。结论本病无特异性临床表现。纤维膜的存在是该病的特征性CT表现。     

腹茧症的病因与诊治(附9例临床分析)

目的探讨腹茧症的病因、临床表现、诊断和治疗。方法对1987～2003年9例腹茧症的病史、临床表现、影像学检查及术中所见进行总结分析。结果术前9例全部被误诊,分别误诊为：急性机械性肠梗阻3例,急性阑尾炎4例,肠套叠1例,小肠平滑肌肉瘤1例。术中见小肠部分（5例）或全部（4例）被一层灰白色光滑、质韧而厚的纤维膜包裹,纤维膜与肠管及肠管与肠管之间黏连疏松,大网膜缺如。手术松解黏连,切除部分纤维包膜。切除的包膜术后作病理检查,9例均为纤维组织。结论腹茧症病因未明确,可能与腹膜发育异常及腹膜炎有关。临床表现以腹部包块和肠梗阻为主要表现,无明显的特征性,术前难以作出明确诊断;术中所见为全部或部分小肠被一层灰白或淡黄色的质韧而厚的纤维膜包襄,切除的包膜术后作病理检查,如为纤维组织,即可确诊;治疗方法为手术松解黏连,切除部分纤维包膜。     

腹茧症的诊治

腹茧症（Abdominalcocoon）又称特发性硬化性腹膜炎（IdiopathicsclerosingISP），是一种罕见的腹部疾病，由Foo等于1978年首先报道并命名。其特点是全部或部分小肠被一层致密、灰白色、质地韧硬厚的纤维膜所包裹。由于本病病因不明，临床少见，术前诊断困难。本文将我院近7年来收治的3例腹茧症报告如下：工临床资料1．1年龄及性别男性1例、女性2例，3例年龄依次为36岁、23岁、28岁。1．2就诊原因2例以肠梗阻就诊，1例以腹部包块就诊。1．3术前检查3例均行腹部平片及CT检查：提示肠梗阻．余无异常发现。1．4治疗方法及结果本组3例均行剖…     

一例腹茧症合并营养不良患者的营养支持护理

腹茧症（Abdominalcocoon,AC）是一种临床罕见、病因不明、由纤维膜包裹部分或全部小肠造成完全性或不全性肠梗阻,以腹部包块为主要表现的腹部疾病,其特点是腹腔全部或部分脏器被一层致密灰白     

腹茧症5例报告

腹茧症是一种少见的腹部病症[1]，以腹腔内异常纤维呈茧样包裹小肠为特征，易误诊误治。近年来，我院收治5例，报告如下。临床资料全组病例均为男性，年龄20～61岁，平均44岁。临床表现：腹痛5例，恶心呕吐4例，肛门停止排便排气2例，腹胀4例。体检：腹块4例，肠型3例，腹膜刺激征1例，肠鸣音亢进3例。腹部X线透视，4例示中下腹肠腔扩张，2例伴液平。CT检查1例疑诊腹内肿块，肠粘连。全组病例发病无明显诱因。术前均未确诊本病，4例诊断为急性小肠梗阻，1例诊断为急性阑尾炎。手术所见：腹腔内一层异常乳白色纤维膜呈茧样包裹部分或全部小…     

Abdominal cocoon associated with endometriosis

Abdominal cocoon is a rare cause of intestinal obstruction in adults. Diagnosis is usually established at laparotomy in patients with recurrent attacks of non-strangulating small bowel obstruction. A 40-year-old infertile Brazilian woman with intestinal obstruction and massive haemoserous ascites, due to coexistent ovarian endometriosis and abdominal cocoon, is reported. Abdominal pain, nausea, vomiting and a palpable mass, in addition to imaging of small bowel obstruction and thickened peritoneum, raised diagnostic suspicion. Higher awareness allows for early diagnoses and yields better results during management.     

腹茧症合并术后早期炎性肠梗阻:1例报告并文献复习

目的:探讨腹茧症合并术后早期炎性肠梗阻的诊断与治疗经验.方法:总结1例腹茧症合并术后早期炎性肠梗阻患者的诊治经验并复习文献.结果:本患者为69岁男性,因阵发性腹痛,肛门停止排气、排便,伴呕吐1 d入院.急诊行剖腹探查术,术中及术后病理证实为腹茧症, 7 d后出现术后早期炎性肠梗阻,经保守治疗痊愈,随访3月正常.结论:腹茧症手术时广泛的粘连分离易导致术后早期炎性肠梗阻,该并发症的治疗应以保守治疗为主;传统的腹茧症手术原则应视情况灵活掌握,不必强求过分的粘连分离,以预防术后早期炎性肠梗阻的发生.     

老年患者结肠癌合并肠梗阻急诊切除加Ⅰ期吻合45例报告

目的探讨结肠癌合并肠梗阻老年患者的急诊处理方法及结局。方法选取北京世纪坛医院收治45例结肠癌合并肠梗阻的老年患者。其中,左半结肠25例,右半结肠20例,均急诊行Ⅰ期吻合术,术中肠道灌洗,对术中污染的8例患者予以切口敞开,术后4～5d再次缝合。结果所有Ⅰ期吻合的患者均无吻合口瘘发生,痊愈出院,左半结肠与右半结肠梗阻在围手术期合并症上无明显差异,切口Ⅲ期缝合可以缩短切口愈合时间。结论如病例选择得当,左半结肠合并肠梗阻者可以同右半结肠一样,进行肿瘤切除后Ⅰ期吻合。     

腹茧症的诊断和治疗1例报告及文献复习

目的: 探讨1例腹茧症病例的临床特点、诊治经验和规范化诊疗流程,并就腹茧症患者的诊断和治疗进行文献复习。方法: 本例患者通过立位腹平片、腹部CT和消化道造影等检查进行消化系统疾病的早期诊断,并及时进行手术治疗和术后病理诊断。结果: 本例患者经影像学检查后及时行开腹手术探查,术中缝合小肠穿孔处肠管,钝锐结合分离小肠表面多处较硬纤维束。术后患者恢复良好,术后病理诊断为腹茧症。结论: 对临床可疑腹茧症的肠梗阻患者进行立位腹平片及腹部CT等影像学检查可明显提高腹茧症的术前诊断率,结合患者症状和体征及时行手术治疗,可挽救患者生命。     

腹茧症6例影像学表现

目的：提高对腹茧症影像学表现的认识。方珐：对6例经手术病理证实为腹茧症的影像学资料进行回顾性分析。站果：有4例X线腹部平片显示不全性小肠梗阻。钡餐检查示小肠聚集重叠于脐周(3例)或偏向左中腹部(1例)，呈盘曲状，钡剂通过缓慢。4例CT检查显示小肠扩张、积液，被一层膜状结构包裹，其中3例肠管间可见膜状间隔。2例B超检查显示小肠聚集，外见一层弱回声组织。站论：腹茧症影像学表现具有一定的特征，密切结合临床，大多数病例能得到正确的诊断。     

基层医院原发性小肠肿瘤24例诊治分析

目的:探讨基层医院原发性小肠肿瘤的诊治方法。方法:回顾性分析我院1993年6月~2007年1月经手术和病理证实的原发性小肠肿瘤24例的临床资料。结果:腹痛、腹胀、梗阻、消化道出血、腹块、黄疸是主要的临床表现,胃、十二指肠镜/上消化道造影对十二指肠肿瘤诊断的阳性率100%,全消化道造影对空回肠诊断阳性率66.7%,B超+CT对小肠肿瘤的诊断阳性率63.2%,术前未能确诊20.8%,恶性肿瘤的根治率33.3%。结论:原发性小肠肿瘤早期诊断困难,对腹痛,腹胀,梗阻,消化道出血,腹块,黄疸的病人,应进行B超、CT、消化道造影、内镜组合检查,无法确诊者,应行剖腹探查。手术是主要的治疗方式,甲磺酸伊马替尼对胃肠间质瘤治疗有重要的作用。螺旋CT、双气囊小肠镜、球囊内镜对提高诊断率甚至早期诊断率有很大的帮助。     

Small bowel obstruction secondary to an appendiceal tourniquet

Background  An 83-year-old lady was admitted with a 3-day history of non-specific abdominal pain that had rapidly increased in severity on the day of admission necessitating an emergency laparotomy. Intra-operative findings demonstrated a mechanical small bowel obstruction secondary to a chronically inflamed appendix acting as a tourniquet around a loop of terminal ileum. Learning point  This case highlights an extremely rare and life-threatening complication of appendicitis. Literature review  True mechanical small bowel obstruction secondary to an acutely or chronically inflamed appendix encircling the distal small bowel remains extremely rare with only ten cases reported in the literature. Conclusion  Clinical assessment remains paramount in the treatment of these patients to facilitate prompt diagnosis and treatment which is vital to provide an optimal platform for post-operative recovery and survival. Although CT imaging is a highly effective investigative modality in these cases, operative treatment should not be delayed for a radiological investigation in the presence of abdominal peritonism.     

Relationship between chronic diarrhea with normal colonoscopy findings and terminal ileum lesions

Background The causes and mechanisms of chronic diarrhea are complex.This study aimed to explore the relationship between chronic diarrhea with normal colonoscopy findings and terminal ileum lesions.Methods All cases were collected from January 2009 to June 2010.The 40 patients in the patient group had chronic diarrhea with normal colonoscopy findings.Those who had hyperthyroidism,diabetes,chronic pancreatitis,cirrhosis,atrophic gastritis,short bowel syndrome and connective tissue diseases had been excluded.The control group contained 40 healthy individuals without diarrhea.Endoscopy of the terminal ileum was applied in both groups,with the endoscope inserted into terminal ileum for more than 20 cm.The patients diagnosed of chronic diarrhea with terminal ileum lesions were treated with metronidazole and probiotics for 10-14 days.Results Before treatment there were significant differences in endoscopy findings of the terminal ileum between the two groups （P 〈0.05）.In the patient group,endoscopy showed congestion,edema,erosion and ulcers in 29 cases,hyperplasia and enlargement of lymphoid follicles in 10 cases with a maximal diameter of 7-8 mm,and 1 case showed normal endoscopy results.After treatment,35 patients recovered from diarrhea,and terminal ileum lesions disappeared in 30 cases as determined by endoscopy.In the control group,endoscopy showed scattered hyperplasia of lymphoid follicles in 5 cases,and the follicles were small with the maximal diameter being 3 mm.There was no hyperemia,edema,erosion or ulcers.Conclusions Chronic diarrhea patients with normal colonoscopy findings may have lesions in the terminal ileum that can be detected by endoscopy; including hyperemia,erosion,ulcers and lymphoid follicle hyperplasia.Therapeutic effect is good with metronidazole and probiotics.     

肾移植术后肺部特异性感染的CT表现

目的探讨肾移植术后特异性肺感染的CT影像表现,提高对特异性肺炎的影像学特点的认识。方法回顾49例肾移植术后合并肺部特异性感染的病例,其中男31例,女18例,年龄21～60岁,平均年龄42岁。发病时间分别为肾移植术后12d～7年。49例患者均进行了胸部螺旋CT及高分辨CT(HRCT)扫描,扫描范围自肺尖至膈面,螺旋CT扫描层厚5mm,层间距5mm;HRCT扫描层厚1mm或0.625mm,层间距10mm。其中侵袭性肺曲霉菌病29例,卡氏肺囊虫肺炎12例,巨细胞病毒肺炎4例,肺结核4例。19例经痰培养证实,20例经纤维支气管镜下肺泡灌洗及支气管肺活检证实,8例经血清学检查证实,2例经尸检证实。影像结果由3位放射科医师进行分析。结果49例患者的CT检查均可见肺内病灶特征性改变。29例侵袭性肺曲霉菌病患者出现最多的肺内异常表现为:肺内磨玻璃影(23/29);多发大小不等结节灶(22/29),支气管血管束周围结节灶(15/29);肺内实变影(18/29),肺内楔形实变影(11/29);晕征(17/29)。12例卡氏肺囊虫肺炎CT影像中均出现肺内弥漫磨玻璃样改变。4例巨细胞病毒肺炎CT影像中都有肺内散在磨玻璃影表现,并伴有小叶间隔增厚;其中3例伴有双肺多发粟粒结节灶;2例伴有胸腔积液。4例肾移植术后肺结核患者的CT影像中均表现为双肺多发粟粒结节灶,其中1例呈"树芽征"表现。结论肾移植术后肺部特异性感染患者中,卡氏肺囊虫肺炎、侵袭性肺曲霉菌病、巨细胞病毒肺炎、肺结核等在CT影像表现上各有特点,CT检查能较早发现肺部异常,并可以在发病早期或病情危重难以获得病原学证据时,通过影像学检查初步判断感染的病原体而得到及时治疗。