手术治疗腹茧症20例临床分析

Clinical analysis of 20 cases of surgically treated abdominal cocoon

目的探讨腹茧症的临床表现、诊断及治疗方法。方法回顾性分析2012-01~2017-06该院收治的20例腹茧症患者的临床资料。结果腹茧症主要临床特征为完全性或部分性肠梗阻(65.0%)和腹部包块(40.0%),10例CT检查示小肠壁增厚、纠集并走形紊乱,8例腹部X线检查示肠管扩张,积气积液,可见液气平面,4例行消化道钡剂造影见近端小肠扩张,局部肠管走形紊乱,集中于中腹部。所有患者均进行手术治疗,8例术后发生并发症(40.0%),肠梗阻3例(15.0%),切口感染3例(15.0%),吻合口瘘1例(5.0%),并发多器官功能障碍综合征(MODS)并死亡1例(5.0%)。结论腹茧症临床特征不典型,术前诊断困难,CT和消化道造影对于术前诊断具有重要价值,治疗主要依靠外科手术,术后并发症发生率高。

Objective To investigate the diagnosis and treatment of abdominal cocoon.Methods The clinical data of 20 cases with abdominal cocoon treated in our hospital from January 2012 to June 2017 were collected and analyzed.Results The main clinical features of abdominal cocoon were complete or incomplete intestinal obstruction(65.0%)and abdominal mass(40.0%).Computed tomography(CT)showed thickened,mustered and disordered bowel wall in 10 cases.Abdominal X-ray showed bowel dilatation with obvious air-fluid level in 8 cases.Gastrointestinal series(barium meal)showed proximal small bowel dilatation,disorder of part bowel and fixed at mid-abdomen[HJ][LM][HJ65x]in 4 cases.All the patients underwent surgical treatment,among whom 8 cases suffered from postoperative complications(40.0%),3 cases suffered from intestinal obstruction(15.0%),3 cases suffered from incisional infection(15.0%),1 case suffered from anastomotic fistula(5.0%)and 1 case died of multiple organ dysfunction syndrome(MODS)(5.0%).Conclusion Clinical features of abdominal cocoon are not typical,and preoperative diagnosis could be difficult.CT and gastrointestinal imaging provide great value for preoperative diagnosis.The treatment mainly focuses on surgery,and the incidence of postoperative complications is high.