41例肠系膜脂膜炎的临床特点分析

Clinical analysis of 41 cases of mesenteric panniculitis

目的分析肠系膜脂膜炎的临床资料,总结其临床特点,提高对该病的认识。方法回顾性分析北京大学第一医院急诊科2015年10月至2020年10月经腹盆部CT诊断的41例肠系膜脂膜炎患者的临床资料。结果 41例肠系膜脂膜炎患者男女比例1∶1.28,平均年龄(51.56±18.62)岁,多因腹痛(95.1%)、发热(19.5%)就诊。58.5%有腹部压痛,39.0%有腹盆部手术史,9.8%有肿瘤病史。48.8%外周血白细胞计数升高,46.3%中性粒细胞百分比升高,22.0%C-反应蛋白升高。CT表现为肠系膜脂肪密度增高、多发大小不等的淋巴结,68.3%有典型的假包膜征,56.1%有脂肪环征。所有患者经抗菌药物及非甾体类抗炎药治疗后症状缓解,经随访无复发。结论肠系膜脂膜炎好发于中老年人,常表现为腹痛等症状,可伴随炎症指标的升高,病因及发病机制不明,可能与腹部手术或创伤、肿瘤、感染等因素相关,诊断主要依赖于腹盆部CT,抗菌药物及非甾体类抗炎药治疗有效。

Objective To analyze the clinical data of mesenteric panniculitis and summarize its clinical characteristics in order to improve the understanding of this disease. Methods The clinical data of 41 patients with mesenteric panniculitis diagnosed by abdominal and pelvic CT in our hospital from October 2015 to October 2020 were analyzed retrospectively. Results 41 patients with mesenteric panniculitis had a male/female ratio of 1 ∶ 1. 28 and an average age of( 51. 56 ± 18. 62) years. The most common symptoms were abdominal pain( 95. 1%),fever( 19. 5%). 58. 5% of the patients had abdominal tenderness,39% of the patients had a history of abdominal or pelvic surgery and 9. 8% had a history of tumor. The leukocyte count in peripheral blood was increased in 48. 8% of the patients,the percentage of neutrophils was increased in 46. 3% of the patients,and C-reactive protein was increased in 22% of the patients. CT findings showed multiple lymph nodes of different sizes with increased mesenteric fat density,68. 3% of the patients had typical pseudocapsule sign and 56. 1% had fat ring sign. All the patients were treated with antibiotics and non-steroidal anti-inflammatory drugs,and no recurrence was found during follow-up. Conclusions Mesenteric panniculitis usually occurs in middle-aged and elderly people,often presents with symptoms such as abdominal pain,and may be accompanied by increased inflammatory indicators. Its etiology and pathogenesis are unknown,and may be related to abdominal surgery,trauma,tumor,infection and other factors. Its diagnosis mainly relies on abdominal and pelvic CT,antibiotics and non-steroidal anti-inflammatory drugs are effective.