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。
Objective To analyze retrospectively the clinical manifestation and radiological findings of abdominal cocoon combined with the diagnosis, treatment and prognosis. Methods The data of 9 patients with abdominal cocoon in our hospital from January 2007 to June 2018 were reviewed including clinical feature and follow-up. Results Four cases were diagnosed as abdominal cocoon by CT examination before operation, and the remaining five cases were diagnosed by laparotomy. One case received non-operative treatment and 8 cases had operation. During the operation, some cases were found part of small intestine to be encapsulated in a cocoon-like membrane, some had all small intestine wrapped and some had part of colon involved. The main operation was to excise cocoon, lysis adhesion and release intestine. One case died due to multiple organ failure and 4 cases had early intestinal obstruction postoperatively. During a follow-up of 8 cases within the period from 6 months to 10 years, 1 case was lost followed up. Chronic abdominal pain was found in 1 case, intestinal obstruction in 2 cases and abdominal distention in 1 case. The other 3 cases recovered well. Conclusions Preoperative diagnosis of abdominal cocoon is difficult for there is no specific clinical manifestations. The characteristic images of abdominal enhanced CT scan with or without two dimensional reformations may be preoperative diagnostic clues. The main treatment of abdominal cocoon is surgery, and the overall prognosis of patients is satisfactory.
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