胆囊切除术中巧遇腹茧症1例并文献复习

1临床资料患者男性,54岁,＂右中上腹疼痛1天＂入院。患者1天前无明显诱因开始出现右中上腹持续性锐痛,伴有右肩部放射性疼痛,不伴恶心呕吐,无发热,无进食后反酸,无嗳气。精神、饮食、大小便可。有高血压病史5年,平时口服珍菊降压片。4年前因左侧腹股沟斜疝行左侧腹股沟斜疝修补术。查体：BP 140/80 mmHg,P 80次/分,神智清楚,呼吸平稳,胸部外形平坦,呼吸音清,心律齐     

腹腔镜诊断腹茧症1例

患者女 ,38岁。因查体发现盆腔包块 2月入院。患者 2 5岁结婚 ,孕0 产0 ,有痛经史 ,无手术史。入院后彩超检查诊断为右侧卵巢囊肿。 2 0 0 2年 9月 2 8日在全麻下行腹腔镜卵巢囊肿剥除术。术中见腹腔自上腹至盆腔被一薄膜包裹 ,大网膜变形 ,长约 5cm ,厚约 1cm。分离子宫附件粘连 ,见右侧卵巢增大约 6cm× 5cm ,囊性。术中诊断为腹茧症、右侧卵巢囊肿、原发不孕症。行右侧卵巢剔除术。术后消炎治疗 ,5d治愈出院。讨　论　腹茧症病因不明 ,多认为与 (1)胚胎发育异常 ;(2 )继发于腹腔内感染 ;(3)月经血返流 ,诱发亚临床腹膜炎 ,纤维渗出 ,机化…     

腹茧症1例报告

患者男性,39岁.因突然持续性剧烈腹痛伴恶心呕吐3 h入院.检查:急性病容,生命体征平稳.腹轻度膨隆,腹式呼吸消失,肝脾未触及.全腹有压痛、反跳痛和肌紧张,肝浊音界未缩小,移动性浊音阳性,肠鸣音减弱.腹腔B型超声无异常,腹平片正常,血淀粉酶正常,白细胞18.5×10 9/L N 93%.诊断为急性弥漫性腹膜炎胃十二指肠穿孔.经胃肠减压、补液、抗生素等积极准备后行急诊剖腹探查术.术中发现全小肠广泛粘连,表面被一层灰白色的膜包裹成团块状,形似蚕茧,与壁层腹膜无粘连,腹腔内有中等量黄色微混浊液体.行小块包膜活检后关腹.     

腹茧症1例报告并文献复习

腹茧症（abdominal cocoon）是一种罕见的腹部疾患,由Foo等于1978年首先报道并命名。本病原因不明,是一种特殊类型的肠梗阻,以小肠全部或部分小肠被茧状包裹在一层异常的纤维膜内为特征,腹痛,腹部包块和肠梗阻为其特点。此前,由于该病的特点为全部或部分小肠被一层致密灰白色、质韧硬厚的纤维所包裹,因此各家命名不同,如局限性小肠系膜包绕症,特发性硬化性腹膜炎,小肠茧状包裹症。目前,腹茧症之名为众家所接受。     

原发性腹茧症1例报告

患者女性,27岁。因反复腹胀、腹痛,呕吐后缓解20余年,伴腹部逐渐膨隆2月入院。中下腹部明显膨隆,无移动性浊音。X线示不完全性肠梗阻,B超示左侧卵巢囊肿、右侧可疑肠间积液,MRI示肠间积液?诊断为多发粘液瘤?肠间积液?行手术治疗,进腹困难,肝、胆、胰、脾无法探查。腹腔内左侧巨     

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。     

腹茧症五例诊治体会

腹茧症临床并不少见，但术前诊断困难，疗效欠佳。1986～1996年，我院共收治5例。本文着重就本病的临床特征与手术方法作初步探讨。临床资料一、一般资料：男4例，女1例，年龄11～56岁，病程6个月～7年，平均28个月。5例均有反复发作腹痛，伴腹部包块、呕吐、无排便排气。查体：全组腹部均呈中度膨隆，触之腹壁“韧”，有“揉面”感，可及局限性包块，4例肠鸣音高亢，1例减弱。发作时腹透均有多个气液平面，其中2例碘剂、3例钡透示小肠蠕动“波幅”较正常人小，位置较固定，加压或改变体位后肠管不易分离，其中1例肠管固定，蠕动“波幅”小…     

腹茧症

腹茧症首由１９７８年被正式命名，迄今文献报道仅５７例。其特点是全部或部分小肠被一层灰白色质韧厚硬的纤维膜外裹，病因不明。临床以腹部包块或肠梗阻为首发症状，手术松解是有效手段。     

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.     

腹腔镜胆囊切除术后腹腔遗留胆石的临床表现和治疗(附1例报告并文献复习)

腹腔镜胆囊切除时,胆囊穿破、胆汁和胆石泄漏入腹腔较为常见,需及时清除。一旦遗留结石在腹腔,可能引起脓肿形成等并发症,需再次手术治疗。现报告1例LC后遗留3cm直径结石于腹腔引起脓肿的临床表现和治疗,并对近期国外文献报告的32例有关资料作了简要复习,并对LC后腹腔遗留胆石并发症的临床表现、诊断和治疗提出了初步意见。     

Idiopathic Abdominal Cocoon: Report of a Case

The abdominal cocoon is a rare disease in which there is total or partial encapsulation of the small bowel by a fibrous membrane. A correct diagnosis is not often made pre-operatively. Awareness of this rare cause of surgical emergency may prevent delay in treatment and avoid unnecessary procedures for the patient, such as bowel resection. We report a patient diagnosed with abdominal cocoon who was subsequently treated.     

腹茧症并泌尿系结石致肠坏死1例经验教训

1病例资料患者,男,45岁。因中下腹痛2 d于2007年4月入院。腹痛呈持续钝痛,无阵发加剧及放射痛,平卧加重,侧卧可缓解;呕吐少量胃内容物1次,不伴返酸、嗳气、腹胀、腹泻。腹部X线、B超、CT检查提示左肾、左输尿管结石,保守治疗无效而转中山大学附属第三医院泌尿外科。发病以来,肛门有排气无排便,小便正常。既往有类似腹痛史数年,均自行缓解;泌尿系结石病史3年。体检T 38.5℃,神清,精神可,中下腹隆起,未见胃肠形及蠕动波;腹肌稍紧,轻压痛、无反跳痛,中下腹扪及30 cm×30 cm包块,无痛、质韧、固定、分界不清;肾区无叩痛;肠鸣音正常。辅助检查:血WBC 25.0×109/L,N 0.91。血淀粉酶18 U/L,肝肾功能正常。尿沉渣:潜血(++),蛋白质(+)。腹部X线平片:左肾、输尿管结石;胃肠道未见液平及膈下游离气体。B超:左肾多发结石、膀胱小结石;肠管内充满粪团及气体强回声。保守治疗1 d,腹痛未缓解,转胃肠外科予禁食、胃肠减压、抗感染、止酸、解痉、生长抑素等治疗,腹痛减[修回日期]2008-12-01轻,胃肠减压呈墨绿色液1 080 m l,腹胀,包块压痛明显,无反跳痛,肠鸣音增强。血WBC 24....     

Abdominal Cocoon in an Aged Man: Report of a Case

An abdominal cocoon is an extremely rare condition, which has been mainly reported in young adolescent women as a cause of small bowel obstruction. In these patients the small bowel is encased in a fibrous sac called an abdominal cocoon. We herein describe a 74-year-old man who demonstrated an abdominal cocoon without having any history associated with an abdominal cocoon. A laparotomy showed bloody ascites and the entire small bowel was encased in a thin white fibrous membrane like a cocoon. The small intestine entered into a defect of the membrane, thus presenting as an internal hernia with intestinal necrosis. The necrotic intestine and the membrane were removed. A histopathological examination of the membrane showed a few signs of inflammation cells.     

Abdominal Wall Haematoma Complicating Laparoscopic Cholecystectomy

Of 61 consecutive patients undergoing laparoscopic cholecystectomy, 4 (6.25%) developed abdominal wall haematomas. This complication of laparoscopic cholecystectomy may occur more commonly than existing literature suggests, and manifests in the post-operative period (days 2 to 6) by visible bruising, excessive pain or an asymptomatic drop in haematocrit. It is readily confirmed by ultrasonography. While no specific treatment is necessary apart from replacement of significant blood loss, the patient requires reassurance that this apparently alarming complication will rapidly resolve.     

上腹部手术后腹腔镜胆囊切除术

目的探讨上腹部手术后腹腔镜胆囊切除术(LC)的可能性及手术方法与技巧。方法回顾性分析我院2005～2009年期间对有上腹部手术史行LC的23例患者的临床资料。结果 23例患者中慢性结石性胆囊炎18例,胆囊息肉5例。既往均有上腹部手术史,其中胃大部切除术后19例,胃平滑肌瘤切除术后2例,脾破裂修补术后2例。采用闭合法穿刺建立气腹,分离粘连,暴露胆囊全貌及Calot三角,顺行或逆行切除胆囊。23例中LC成功21例;因粘连致密,胆囊管无法辨认,中转开腹2例。手术时间45～140min,平均67min.全组无明显出血、内脏损伤、胆管损伤、胆汁漏等并发症发生。结论部分上腹部手术后胆囊良性疾病行LC术可行。     

肝包膜下胆汁瘤1例报道并文献复习

目的 总结肝包膜下胆汁瘤（HSB）的病因、临床诊断及治疗方法。方法 回顾性分析笔者所在医院收治的1例HSB患者的临床资料,并进行文献复习。结果 12例患者中,术前诊断为胆总管结石/胆囊结石慢性胆囊炎4例,胆总管结石1例,胆囊结石2例,急性化脓性胆囊炎2例,不详3例;行腹腔镜胆囊切除术（LC） 7例,行内窥镜逆行胰胆管造影1例,行LC＋腹腔镜胆管取石术1例,行开腹胆囊切除术3例;发病至手术时间7～40 d,平均14.3 d;右肝9例,胆囊窝及右肝前叶膈顶部、胆囊窝及右肝后叶和左肝各1例;11例单发,1例左肝多发;HSB直径7.6～29.1 cm,平均15.7 cm;肝脏包膜下积液量800～3 000 mL,平均1 400 mL;液体吸收时间7～120 d,平均37 d。主要治疗方案为置管引流7例（包括手术开腹置管外引流2例）,B超引导下反复穿刺抽吸4例,1例不详;2例反复穿刺引流效果较差,行手术治疗。结论 HSB的发病原因目前尚无统一意见,诊断首选影像学检查,治疗以保守治疗＋B超引导下经皮反复穿刺抽吸为主。     

肾脏后肾腺瘤1例报告并文献复习

目的：探讨后肾腺瘤的临床病理学特征,提高对后肾腺瘤的认识.方法：分析1例29岁女性后肾腺瘤患者的临床病理资料,并结合相关文献进行讨论.结果：患者因腰部不适行B超检查发现右肾肿瘤,16层螺旋CT诊断为右肾肿瘤（良性可能大）,行肾肿瘤剜除术,术中见肿瘤被膜完整,切面色灰白,质地均匀,术中冷冻切片诊断为乳头状肾细胞癌,随即行肾癌根治术.镜下肿瘤细胞呈腺样或乳头状排列,并有砂粒体.免疫组化：NSE（＋）、Ki67、Vim为阳性.病理诊断：右肾后肾腺瘤.随访22个月,未见肿瘤复发.结论：后肾腺瘤术前难以依据影像学特征明确诊断,术前肿瘤穿刺活检结合免疫组化对明确诊断可能是一种可行的选择,更重要的是,了解其临床及病理特点有助于该肿瘤的准确诊断.后肾腺瘤的治疗多采取保留肾单位的手术,但由于其生物学行为及细胞起源的不确定性,术后长期随访观察是必需的.     

Heterotopic Mesenteric Ossification After a Ruptured Abdominal Aortic Aneurism: Case Report With a Review of Literatures

Heterotopic mesenteric ossification (HMO) is a rare disease that results in intra-abdominal ossification of unknown origin. An 88-year-old man developed an intestinal obstruction 2 weeks after undergoing an operation for a ruptured abdominal aortic aneurysm, resulting in intestinal obstructions those did not improved concervatively. During relaparotomy performed 30 days after the first operation, hard adhesions of the small intestine and mesentery were found; these adhesions were difficult to separate without damaging the serosa of the small intestine. We removed 240cm of the small intestine and performed a jejuno-ileo anastomosis. Microscopically, trabecular bone tissue had increased irregularly in the fat tissue of the nodules with fibrosis, which were partially lined with osteoblasts. Accordingly, we histopathologically diagnosed the patient as having HMO. The patient was treated with NSAIDs and cimetidine to prevent the recurrence of HMO. No signs of recurrence have occurred as of one year after the second operation.Key words: Heterotopic mesenteric ossification, Ileus, Obstruction, Small bowel, Aortic aneurysmHeterotopic mesenteric ossification (HMO) is a rare disease resulting in intra-abdominal bone formation of unknown origin that can lead to serious complications, such as intestinal obstruction, enterocutaneous fistulation, intestinal perforation, sepsis, or even death. These complications may require surgical therapy. Here, we report an extreme, rare case of HMO that occurred after an operation for a ruptured abdominal aortic aneurysm (AAA), with a review of the literature.