腹茧症临床分析(附9例报告)

目的:探讨腹茧症的临床表现、影像学表现、诊断、治疗和预后。方法:回顾性分析2007年1月至2018年6月我院诊治的9例腹茧症病人的资料,包括临床表现、影像学表现、诊断、治疗和随访结果。结果:4例术前CT检查明确诊断腹茧症,余5例经剖腹探查确诊。1例接受非手术治疗好转,8例手术治疗。术中发现部分或全部小肠或伴有部分结肠包裹在纤维茧状膜中。手术方式为腹茧切除,肠粘连松解。术后1例死于多脏器功能衰竭,另4例术后并发早期肠梗阻。8例生存病人中,1例失访,7例随访6个月至10年,其中1例慢性腹痛,2例肠梗阻,1例腹胀,3例情况良好。结论:腹茧症的临床表现为非特异性,术前诊断较困难。腹部增强CT伴或不伴二维图像重建检查的特征性图像是术前诊断的关键。手术治疗是首选,总体预后满意。     

腹茧症的诊治体会（附9例报道）

目的 提高对腹茧症的认识和临床诊治水平.方法 回顾性分析我院1995～2008年期间收治的9例腹茧症患者的临床资料.结果 9例患者中5例以急、慢性肠梗阻症状为主要表现,结合CT、彩超、腹部X线平片等检查,2例术前诊断为腹茧症.9例患者经手术治疗后均获得成功.8例得到随访,随访时间6～84个月,平均(26±13)个月,2例分别于术后3及10个月出现肠梗阻,经保守治疗后治愈,其余无相关手术并发症发生.结论 患者反复有肠梗阻表现而梗阻原因不明或出现腹部包块,需结合合理的影像学检查考虑腹茧症的可能;手术是本病诊断和治疗的有效手段.     

腹茧症16例诊治体会

目的 探讨腹茧症的诊断及治疗方法。方法 回顾性分析l6例腹茧症的临床资料及随访结果。结果 16例腹茧症均经手术治疗并确诊。术前11例误诊为机械性肠梗阻2～l0年，4例为误诊慢性阑尾炎，l例误诊为腹部肿块。术后并发症2例，全部患者均临床治愈。并获随访1～l0年，2例分别因反复发作肠梗阻于1年和5年死亡，2例反复发作不完全性肠梗阻合并营养不良，12例情况良好。结论 腹茧症术前诊断困难，上消化道造影和B超及CT对诊断可能有帮助；包膜切除，肠粘连松解是治疗本病的有效方法。     

腹茧症的外科治疗

目的探讨腹茧症的诊断及治疗. 方法回顾性总结6例腹茧症的临床资料. 结果 6例腹茧症患者术前均误诊,5例诊为肠梗阻,1例诊为腹部包块,6例均给予全部或部分包膜切除术,1例行肠排列术. 结论腹茧症临床表现无特异性,术前诊断困难.上消化道造影、B超及CT对诊断有帮助.治疗常选择行全部或部分包膜切除、肠排列、肠切除、粘连松解术.     

持续性不卧床腹膜透析合并腹茧症的诊治

目的:探讨持续性不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)合并腹茧症患者的诊断及治疗方法。方法:回顾分析14例CAPD并发腹茧症患者的临床资料。结果:14例腹茧症均经手术或腹腔镜探查确诊。腹腔镜探查时患者无死亡病例及并发症发生,术后发生并发症5例,死亡1例。随访2~10年,6例患者死于尿毒症及合并症,3例反复发作不完全性肠梗阻,均经非手术治疗痊愈。结论:CAPD并发腹茧症术前诊断困难,影像学检查及腹腔镜探查有助于明确诊断。手术并发症及死亡率较高,手术松解、解除梗阻是有效的治疗手段。     

腹茧症三例诊治分析

探讨腹茧症的发病原因、诊断及治疗方法。报告收治腹茧症3例，年龄分别为13、12、36岁；分别以“急性阑尾炎并不全性肠梗阻”、“急性阑尾炎”、“脾蒂扭转”急诊手术，术中证实为腹茧症。均治愈。结合文献对本病的病因、诊断、手术方法进行分析，认为该病病因为先天发育异常加之各种原因引起腹腔渗出，使包膜增厚；术前诊断困难；手术治疗可松解包膜、解除梗阻。     

腹茧症的诊断和治疗(附5例报告)

目的探讨腹茧症的诊断和治疗方法。方法对5例患者均行手术治疗,回顾分析患者的临床资料。结果 5例中有3例以急性肠梗阻为主要临床表现,2例以局限性腹膜炎并不全肠梗阻为主要表现。4例手术获得成功,1例术后反复出现腹痛、腹胀、肛门排气排便减少等症状,于术后23 d经中药治疗后痊愈。3例得到随访,随访时间2～18个月,平均9个月,患者恢复良好。结论腹茧症虽有肠梗阻表现,但梗阻原因不明,术前诊断比较困难,误诊率高。手术是诊治本病的有效手段。     

腹茧症的诊治体会（附8例报告）

目的　探讨腹茧症的诊断和治疗方法。方法　回顾性分析本院收治的 8例腹茧症病人的临床资料。结果　术前无一例确诊。均剖腹探查行粘连松解术。有 3例同时行小肠部分切除 ,其中 1例术后出现短肠综合征 ;2例同时行肠排列术 ,术后 1月内因粘连性肠梗阻再次剖腹探查 ,行粘连松解术 ,术后并发小肠瘘 ,死亡 1例。结论　腹茧症临床表现无特异性 ,术前确诊困难。手术治疗是唯一有效的治疗方法 ,手术方式以单纯粘连松解术为宜     

腹茧症诊治体会

目的 探讨腹茧症的特征和诊治方法.方法 回顾我院1997年3月至2005年3月收治的5例腹茧症患者的临床资料,结合文献报道,就该病特点及诊治经验进行探讨.结果 本组病例2例曾有腹部手术史,4例表现为急、慢性不完全性肠梗阻,1例因胆总管结石,术中明确诊断;所有病例均行手术治疗,术中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,术后全部治愈出院.结论 腹茧症是一种较为少见的疾病,当遇到无法解释的急、慢性肠梗阻患者时,应考虑本病可能;放射学检查能协助诊断,手术发现全部或部分小肠为一层致密、灰白色质韧、硬厚的纤维膜所包裹则能确诊;手术是首选治疗方法.     

腹茧症的诊断与治疗

本研究探讨腹茧症的影像学特征以及外科手术治疗的操作要点。回顾性总结12例腹茧症患者资料,分析其临床特征、CT和X线钡餐透视检查资料以及手术治疗方式。腹茧症患者的CT征象为可延迟增强的包裹小肠纤维包膜,X线钡餐透视示造影剂长时间不能排空。手术探查发现患者小肠全部或部分被一层灰白色、质密的纤维膜包裹。消化道X线钡餐造影和腹部CT检查对于原发性腹茧症患者的术前诊断具有重要价值,而手术是最有效的治疗方法。     

A rare cause of small bowel obstruction: Abdominal cocoon

INTRODUCTIONThe clinical manifestations of abdominal ‘cocoon’ are non-specific and hence its diagnosis is rarely made preoperatively and the management is often delayed. Surgery remains the main stay of treatment with satisfactory outcome and comprises excision of the fibrous membrane, meticulous adhesionolysis and release of the entrapped small bowel.PRESENTATION OF CASEA 45-year-old male patient presented with 6-month history of progressive subacute small bowel obstruction. After initial radiological investigations, he underwent diagnostic laparoscopy and was misdiagnosed as abdominal tuberculosis. He was started on anti-tuberculous therapy, but exploratory laparotomy was carried out after failure to respond to anti-tuberculous therapy. At laparotomy, the abdominal ‘cocoon’ which was encapsulating the entire small bowel was excised, and the adhesions were carefully lysed. The patient remained well and without recurrence at 1-year follow-up.DISCUSSIONAbdominal ‘cocoon’ is a rare cause of subacute, acute and chronic small bowel obstruction. Its diagnosis is rarely made preoperatively.CONCLUSIONAbdominal ‘cocoon’ should be thought of as a rare cause of small bowel obstruction. It may be mistaken with abdominal tuberculosis. Surgery remains the mainstay of curative treatment.     

腹腔镜手术在腹茧症治疗中的安全性及可行性研究

目的探讨腹腔镜手术在腹茧症治疗中的安全性和有效性。 方法回顾性分析2016年1月至2019年11月期间在上海交通大学医学院附属第九人民医院就诊共计13例接受外科手术的腹茧症患者的临床资料。 结果13例患者的外科手术均顺利完成,其中8例腹腔镜手术、5例传统手术。所有患者因肠梗阻症状而就诊,均进行茧膜切除及肠粘连松解术。由于既往腹部手术史,5例采用传统手术方式。相较于传统手术,腹腔镜手术组的术中出血量减少[(116.3 ± 14.0)ml比(180.6 ± 24.9)ml,P< 0.05],手术时间缩短[(99.3 ± 8.7)min比(130.6 ± 7.5)min,P<0.05]。腹腔镜组与传统手术组分别出现4例、3例术后并发症(P> 0.05);术后肠梗阻分别3例、2例(P>0.05);术后住院时间(11.4 ± 3.5)d和(13.4 ± 5.2)d(P> 0.05)。13例患者术后病理均提示纤维性包膜。 结论腹腔镜手术对于既往无腹部手术史腹茧症治疗是安全、有效的。     

The role of laparoscopy in patients with suspected peritonitis: experience of a single institution

PURPOSE: In this report, we retrospectively evaluate the effect of a laparoscopic approach in the diagnosis and treatment of acute abdominal pain in patients with suspected peritonitis. PATIENTS AND METHODS: We evaluated the clinical records of patients admitted to our institution between January 1995 and July 2001 with a diagnosis of acute abdomen and suspected peritonitis. RESULTS: Ninety four of 229 patients underwent diagnostic laparoscopy. In this series, 83 (88.3%) of the cases were successfully treated by emergent laparoscopy for an acute abdomen. Eleven (11.7%) required conversion to an open laparotomy procedure. Overall, the preoperative diagnosis was confirmed by laparoscopy in 67 (71.27%) of the cases. It was not confirmed in 27 (28.73%). Postoperative mortality was 4.25%. Morbidity was 8.5%. DISCUSSION: Data reported in the literature establish that laparoscopy offers adequate visualization of the entire abdomen and pelvic cavity in the diagnosis of an abdomen acute secondary to peritonitis. In this series, laparoscopy confirmed the diagnosis in 97.8% of the patients, and minimally invasive treatment was achieved in 88.3% of the cases. Female patients with gynecologic disease particularly benefitted from a laparoscopic approach, which permitted the correct evaluation of this condition and may have prevented unnecessary laparotomy. We believe that laparoscopy is an accurate modality for the diagnosis and treatment of patients with an acute abdomen and suspected peritonitis when the diagnosis cannot be clearly made by physical examination and noninvasive methods.     

腹腔镜诊治急慢性腹痛37例分析

目的 :探讨腹腔镜在诊断和治疗不明原因急慢性腹痛中的作用。方法 :回顾分析不明原因急慢性腹痛 37例的临床资料。结果 :急性腹痛 15例中 ,11例行腹腔镜治疗 ,2例未行外科处理 ,2例开腹手术。无误诊及漏诊。治疗患者术后腹痛均明显好转或治愈 ,有效率为 10 0 %。慢性腹痛 2 2例 ,镜下诊断 2 1例 ,其中 1例误诊。 12例行腹腔镜治疗 ,3例行开腹手术 ,6例未进一步手术治疗。 1例腹腔镜下未见异常。手术治疗者近期效果均良好 ,有效率为 93%(14 / 15 )。所有急慢性腹痛患者腹腔镜探查或治疗均无严重并发症。腹腔镜术后 3～ 6d出院。结论 :腹腔镜诊断急慢性腹痛准确率较高 ,腹腔镜治疗减少了患者痛苦 ,缩短了住院时间。腹腔镜应作为外科诊治不明原因急慢性腹痛患者的首选方法。     

原发性腹茧症的诊断与治疗

目的 探讨腹茧症临床特点及诊治方法。方法分析2000年7月-2004年2月收治的9例腹茧症患者的临床资料。结果9例中8例表现为急、慢性肠梗阻的症状。5例有腹部包块。9例患者中8例术前进行了腹部X线平片、CT检查,均发现不全性肠梗阻。4例CT发现腹膜及肠管管壁增厚强化,肠壁间粘连紧密;4例CT发现腹腔内小肠径路紊乱,聚集成团,似可见增厚的包膜包裹。3例进行了消化道钡餐检查,其中1例无异常,1例不全性肠梗阻,1例小肠集中于中腹部。剖腹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9例全部治愈。结论患者反复出现急性或慢性肠梗阻症状,而又无其他原因解释或合并腹部包块者,应考虑腹茧症的可能。术前放射学检查对本病的诊断很有价值。手术是主要的治疗方法。     

腹腔镜治疗妇科急腹症55例临床分析

目的:评价腹腔镜对诊治妇科急腹症的临床价值。方法:应用腹腔镜对以急性腹痛为临床表现且初步排除急性盆腔炎症后的妇科急症55例进行了腹腔镜手术并进行临床分析。结果:腹腔镜在妇科急腹症中的应用范围日益扩大,绝大多数妇科急腹症可在腹腔镜下进行。结论:与传统的开腹手术相比,腹腔镜妇科急腹症手术具有切口小,出血少,患者康复快,术后不留疤痕等优点,适合在妇科急腹症中应用。     

腹茧症203例综合分析

目的探讨腹茧症的临床特点及诊治方法。方法综合分析203例腹茧症患者的临床资料，其中我院7例，国内文献报道196例。结果患者男：女为1．2：1，平均年龄33岁。临床表现以急、慢性肠梗阻为主者147例（72．4％），腹部包块53例（26．1％）。术前检查包括X线腹部拍片163例，B超85例，CT68例，钡餐透视32例。术前6例（3．0％）诊断为腹茧症。所有病例均行手术治疗，其中纤维包膜切除、肠粘连松解172例（84．7％），同时小肠部分切除34例（16．7％）。同时阑尾切除5l例（25．1％）；单纯阑尾切除2l例（10．3％）。术后再次并发肠梗阻55例（27．1％），保守治愈37例。再手术18例。192例（94．6％）治愈，死亡11例（5．4％）。结论腹茧症术前诊断困难。有肠梗阻表现者宜行手术治疗。复发粘连性肠梗阻是术后主要并发症，慎再次手术。     

Free abdominal fluid on ultrasound in unstable pelvic ring fracture: is laparotomy always necessary?

BACKGROUND: In unstable pelvic ring fractures free abdominal fluid on ultrasound (US) may be caused by retroperitoneal hematoma that passes into the abdominal cavity or by an additional intraabdominal lesion. In this study a clinical pathway for the therapy of potentially combined lesions was analyzed. PATIENTS AND METHODS: All patients treated in the ED for severe trauma underwent basic sonographical and radiologic diagnostics within 15 minutes. of admission. Data were prospectively documented. According to the treatment protocol unstable pelvic ring fractures with initial free fluid on US received laparotomy. Patients with stable vital conditions had abdominal CT-Scan before surgery. RESULTS: 1472 consecutive severely injured patients (ISS 20, age: 39 years) were included. Eighty subjects had sustained type B (47) or C (33) pelvic ring fracture. Early free abdominal fluid on US was absent in 49 cases. Three patients in this group required celiotomy later on, during ICU treatment. In 31 patients free fluid was present. All of them had laparotomy. Only one patient showed retroperitoneal hematoma alone, while all others had one or more significant lesions (rupture) that required surgical repair. Simultaneously with laparotomy pelvic stabilization was performed by external (19) or internal (6) fixation. In all cases with massive pelvic hemorrhage and free fluid in US bleeding was controlled by internal tamponade and external fixation. CONCLUSION: The finding of intraperitoneal fluid on US in the emergency department strongly correlates with significant intraabdominal lesions requiring surgical intervention. Early laparotomy appears indicated in these cases. Shock control in pelvic bleeding can be sufficiently achieved by internal tamponade and external fixation.     

The Abdominal Cocoon. A Case Report

The abdominal cocoon, or idiopathic sclerosing encapsulating peritonitis, is a rare cause of intestinal obstruction. This rare condition, in which the small intestine is encased in a thick fibrous membrane, has been reported predominantly in females. Despite some reports of a preoperative diagnosis, in the majority of cases diagnosis is only made at laparotomy for acute or subacute intestinal obstruction. Treatment consists of resection of the membrane with lysis of adhesions. We present a case of abdominal cocoon in a man where early preoperative diagnosis by radiological evaluation was overlooked. A better awareness of this condition may result in early diagnosis and proper management, thus avoiding unnecessary bowel resections and bad outcomes.     

Laparoscopy in patients admitted for acute abdominal pain

In 81 patients with acute abdominal pain, laparoscopy was performed because of diagnostic doubt. Diagnosis by clinical methods proved to be correct in 42 of the patients and laparoscopy gave correct diagnosis in 70. Appendectomy revealed acute appendicitis in 19 patients and normal appendix in five. Failure to establish a diagnosis by laparoscopy was due to incomplete visualization of appendix in nine patients, pelvic adhesions in one patient, and failure to enter the peritoneal cavity in another. A clinical diagnosis of acute appendicitis could be invalidated by laparoscopy in 17 of 40 patients. Negative laparotomy is potentially avoidable by use of laparoscopy when a diagnosis of appendicitis is questionable. Laparoscopy may therefore be warrantable in such cases.