小肠禁锢症的病因、诊断与治疗探讨(附12例报告)

Diagnosis and treatment of peritoneal encapsulation and abdominal cocoon:A report of 12 cases

目的提高对小肠禁锢症的认识、诊断及处理水平。方法对12例小肠禁锢症患者的临床资料进行回顾性分析。结果本组12例患者包括腹膜包绕型(PE)和茧壳症型(AC),其中6例行包膜切除,粘连肠管松解术;3例因肠管狭窄而行部分小肠切除吻合术;脾破裂及阑尾炎各1例,术中发现该病后未做特殊处理。术后除2例失访外,9例随时间超过1年,其中7例临床症状消失,未复发,2例时有腹部隐痛,饭后饱胀不适,但不影响日常生活及工作,未做特殊处理。另1例在行阑尾切除的同时进行了包膜切除的患者,术后半年出现肠梗阻症状,行二次肠排列术后治愈。结论小肠禁锢症PE型因症状轻微或无症状,常在无意中发现,不宜手术治疗,而腹部AC型若出现肠梗阻,经保守治疗无效或反复发作应手术治疗。术式包括包膜大部分切除、肠粘连松解及肠排列等。

Objective To improve cognation and the levels of diagnosis and treatment for peritoneal encapsulation and abdominal cocoon.Methods The clinical data from 12 patients with peritoneal encapsulation and abdominal cocoon were retrospectively analyzed.Results In 12 patients including of type peritoneal encapsulation(PE)and type abdominal cocoon (AC),capsulectomy and lysis for adhesive intestinal canals in 6 cases,partial enteroectomy and anastomosis in 3 cases for enterostenosis,splenic rupture 1 case and appendicitis 1 case.The follow-up period in 9 patients got above 1 year in addition to 2 losed following-up patients,the subsided symptoms without required treatment in 7 cases, the abdominal insidious pain and postprandial satiety in 2 cases with not required treatment.In other 1 case,appendectomy and capsulectomy were performed,and symptoms of ileus was recurrence on 6 month after operation,but cured by second intestinal array.Conclusion The type PE with slight or no symptom is unsuitable to operation,and the type AC with intestinal obstruction and without effect conservation treatment should be operated or repeat outbreak symptom.Operation including:incision of partial envelope,enterolysis and intestinal array et al.