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。

Diagnosis and treatment of the abdominal cocoon ( report of 9 cases)

Objective To investigate the etiology,the clinical manifestation,the diagnosis and the treatment of the abdominal cocoon.Methods 9 cases of the abdominal cocoon from 1987 to 2003 were reported whose histories, clinical manifestations,imaging examinations,surgical operation findings were analyzed.Results All of the 9 cases were misdiagnosed preoperatively as acute mechanical intestinal obstruction(3 cases),acute appendicitis(4 cases),intussusception(1 cases) and small intestine leiomyosarcoma(1 cases) respectively.During the surgical operation,the intestine could be seen encapsulated totally or partially in a thick hoary fibroid membrane.The adhesion between the fibroid membrane and the intestine was loose.None of the epiploon could be found.The operation to relieve the adhesion and excise part of the fibroid membrane was performed.The pathological diagnosis of excised membrane of all the 9 cases was fibre tissue.Conclusion The etiology of the abdominal cocoon is largely unknown.It may be associated with peritoneal heteroplasia and peritonitis.Its clinical manifestations without characteristic are intestinal obstruction and abdominal mass mainly,so the correct diagnosis of the abdominal cocoon can not easily work out preoperatively.The diagnosis of the abdominal cocoon will be definite if the small intestine was encapsulated totally or partially in a thick hoary fibroid membrane and the pathological diagnosis of excised membrane is fibre tissue.The treatment is to relieve the adhesion and excise part of the fibroid membrane.