腹茧症203例综合分析

Comprehensive analysis of 203 cases with abdominal cocoon

目的探讨腹茧症的临床特点及诊治方法。方法综合分析203例腹茧症患者的临床资料,其中我院7例,国内文献报道196例。结果患者男∶女为1.2∶1,平均年龄33岁。临床表现以急、慢性肠梗阻为主者147例(72.4%),腹部包块53例(26.1%)。术前检查包括X线腹部拍片163例,B超85例,CT68例,钡餐透视32例。术前6例(3.0%)诊断为腹茧症。所有病例均行手术治疗,其中纤维包膜切除、肠粘连松解172例(84.7%),同时小肠部分切除34例(16.7%),同时阑尾切除51例(25.1%);单纯阑尾切除21例(10.3%)。术后再次并发肠梗阻55例(27.1%),保守治愈37例,再手术18例。192例(94.6%)治愈,死亡11例(5.4%)。结论腹茧症术前诊断困难。有肠梗阻表现者宜行手术治疗。复发粘连性肠梗阻是术后主要并发症,慎再次手术。

Objective To explore the clinical characteristics, diagnosis and treatment of abdominal cocoon. Methods Clinical data of 203 cases with abdominal cocoon including 7 cases in our hospital and 196 cases reported in Chinese literature from January 1995 to June 2005 were analyzed retrospectively. Results The male to female ratio was approximately 1.2： 1. The mean age at diagnosis was 33 years. The main clinical manifestations included recurrent acute or chronic intestinal obstruction in 147 cases （72. 4% ）, abdominal mass in 53 cases （26. 1% ）. Of the 203 cases, abdominal plain X-ray were performed in 163, B-ultrasound in 85, CT in 68 and barium meal in 32 cases, however, only 6 cases（3.0% ） were diagnosed as abdominal cocoon preoperatively. All the cases received operations included partial or total excision of the membrane and enterolysis in 172 cases（84. 7% ）, together with bowel resection in 34 cases（16. 7% ） and appendectomy in 51 cases（25.1% ） . Postoperative complications included recurrent obstruction in 55, and death in 11 cases（5. 4% ）. Conclusions The preoperative diagnosis of abdominal cocoon is difficult. Operations should be performed on the cases with intestine obstruction. Recurrent adhesive intestinal obstruction is the main postoperative complication.