原发性腹茧症外科治疗67例临床分析

Surgical treatment for idiopathic abdominal cocoon

【目的】探讨原发性腹茧症的临床特征、诊断及治疗方法。【方法】回顾性分析2000年1月至2011年1月67例腹茧症患者的临床及随访资料。【结果】共纳入腹茧症患者67例，其中首次在我科接受外科治疗的患者43例，为行进一步治疗由外院转入的患者24例。总体术前诊断率为47.8%（32/67）。在我院接受手术治疗的47例患者，患者术后并发症发生率为44.7%（21/47），其中并发术后早期炎性肠梗阻为21.3%（10/47）。术前行肠内营养支持的患者术后并发症率（8/27）显著低于术前未行营养支持者（13/20，χ2=5.815，P〈0.05）；术中所见纤维膜粘连包裹局限者较广泛粘连包裹者术后发生早期炎性肠梗阻的概率较低（分别为9/25、1/22，χ2=6.912，P〈0.05）。【结论】围手术期处理和手术操作是腹茧症患者取得良好治疗效果的关键。彻底切除茧膜和小肠内排列是手术成功的技术要点，术前肠内营养支持可以有效降低术后肠梗阻等并发症的发生。

Objective To investigate diagnosis and treatment of abdominal cocoon. Methods Clinical data of patients received treatment for abdominal cocoon from January 2000 to January 2011 was retrospectively analyzed. Results A total of 67 patients underwent treatment in our hospital were analyzed, the preoperatively diagnosis rate was only 47.8% （32/67）. Patients who received preoperatively nutrition support have a lower postoperative complication （8/27 vs. 13/20, X^2 =5. 815, P 〈0. 05） and patients with less extent of intestine involved had a lower early postoperative inflammatory ileus （ EPII ） rate （ 9/25 vs. 1/22, X^2 = 6. 912, P 〈 0. 05 ） when compared with large extent. Conclusions Appropriate perioperative management play an important role in the prognosis of abdominal cocoon. The main treatment is surgery while preoperatively nutrition support can reduce postoperative complications.