原发性腹茧症的影像学特征、治疗及预后分析

Analysis of imaging characteristics,treatment and prognostic factors of primary abdominal cocoon

目的研究原发性腹茧症的影像学特点和预后影响因素。方法回顾性分析首都医科大学附属北京天坛医院普外科2000年1月～2009年12月收治的原发性腹茧症患者的临床特征、CT检查资料、治疗方法和预后。结果全部6例均表现为肠梗阻。腹部X线平片可见小肠扩张积气肠袢及液气平面。腹部CT检查可见小肠扩张聚集成团,其周围似可见增厚的包膜包裹。腹部B超检查均发现小肠肠管部分扩张,4例可见少量腹水。5例进行了消化道钡餐检查,均提示回肠远端钡剂通过缓慢,其中1例提示回肠远端狭窄,另1例造影后出现完全性肠梗阻。剖腹探查术中均显示全部或部分小肠被一层灰白色致密坚韧的纤维膜包裹,大网膜缺如。均行部分纤维膜剥除、粘连松解术等,1例同时行部分小肠切除术。术后6例全部治愈。结论消化道造影和腹部CT检查对于原发性腹茧症具有重要的诊断价值。手术是安全有效的治疗方法。

Objective To investigate the imaging characteristics and prognostic factors of primary abdominal cocoon.Methods The clinical features,CT information,treatment and prognosis of patients with primary abdominal cocoon in Beijing Tiantan Hospital from January 2000 to December 2009 were retrospectively analyzed.Results All 6 patients showed an obstruction.Abdominal plain X-ray showed intestinal loop expansion of product gas and liquid gas plane in the small bowel.Abdominal CT examination showed a conglomeration of multiple small bowel loops encapsulated in a thickened capsule.Abdominal ultrasound examination showed some expansion of small bowel and 4 patients showed a small amount of ascites.Five patients had barium meal examination,all demonstrated barium slowly moved through the distal ileum,with one of the 5 patients showing stenosis in the distal ileum,another one showed complete obstruction.Laparotomy revealed that all or part of the small intestine was wrapped by a layer of dense gray tough fibrous membrane and the omentum was absent.All the patients underwent partial fiber membrane cystectomy,adhesion lysis,etc.,1 case underwent partial small bowel resection.All patients were cured.Conclusion Gastrointestinal imaging and abdominal CT examination has important diagnostic value for primary abdominal cocoon.Surgery is a safe and effective treatment.