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。

Diagnosis and treatment of abdominal cocoon

Objective To study the clinical characteristics and the methods of diagnosis and treatment for abdominal cocoon. Methods The clinical data of 9 patients with abdominal cocoon treated from July 2000 to February 2004 were analyzed. Results The clinical manifestations included abdominal pain, abdominal distention, nausea, vomiting, partial or complete intestinal obstruction in 4 cases among 9 cases, abdominal mass in 5 cases. Abdominal plain X-ray and computed tomography suggested partial intestinal obstruction in 8 cases. Computed tomography suggested thickening and rigidity in peritoneum and intestinal wall even a part of calcification in 4 cases. The intestinal loops seemed to be encapsulated in a thickened capsule. Contrast study was negative in 1 case, partial intestinal obstruction in 1 case and intestinal loops fixed at middle abdomen in 1 case among 3 cases. All the cases underwent operations, which showed that part or all the small bowel were encapsulated in a dense white membrane. Conclusions~Abdominal cocoon is rare. It is more difficult to make right diagnosis preoperatively. A better awareness of this disease and the combination of clinic and radiology may be facilitated in preoperative diagnosis. Abdominal cocoon may be considered when recurrent acute or chronic intestinal obstruction. Surgery was the first choice of therapy.