高龄患者腹腔游离体一例并文献复习

Peritoneal loose body in an elderly patient:a case report and literature review

腹腔游离体又称“腹腔鼠”,临床少见,诊断较为困难,常在术中偶然发现。本文分析北京医院行腹腔镜手术的1例术后诊断为腹腔游离体(PLB)的高龄患者,并结合文献复习加以总结。我们通过PubMed和知网数据库检索到了文献报道的PLB案例(含本例)共86例,案例年龄从16岁到81岁不等,平均年龄为55岁,其中男性66例(76.7%),女性20例(23.3%);多数患者是无症状或术中偶然发现的,部分以腹痛或腹部不适为主诉就诊,少数可表现为尿频、尿潴留。PLB大多单发存在,占80例(93%),仅6例(7.0%)为多发;术前常误诊断为膀胱结石、胆道结石、畸胎瘤、间质瘤等。术中发现PLB可位于盆腹腔的各种位置,盆腔区最常见为52例(60.5%)。发现PLB时最大径可达20 cm,通常长径大小为1 cm~10 cm。腹部外科相关科室(普外科、泌尿外科、妇产科等)应该重视PLB的临床表现、诊断和治疗,减少因误诊给患者带来的损害。

Peritoneal loose bodies,or peritoneal mices,are rare in clinic and difficult to diagnose which are usually found during abdominal surgery.An elderly patient with peritoneal loose body who underwent laparoscopic surgery in Beijing Hospital was analyzed and summarized based on literature review.We retrieved a total of 86 cases of peritoneal loose bodies(including this case)reported from PubMed and CNKI.The age of the cases ranged from 16 to 81 years old,with an average age of 55 years.Among them,66 cases(76.7%)were male and 20 cases(23.3%)were female.Most of the patients were asymptomatic and found incidentally,some of them complained of abdominal pain or abdominal discomfort,and a few of them may manifested as urinary frequency and urinary retention.Most of the peritoneal loose bodies were single,accounting for 80 cases(93%),and only 6 cases(7.0%)were multiple.Preoperatively,they were often misdiagnosed as bladder stones,gallstones,teratomas,and stromal tumors.When peritoneal loose bodies were found during surgery,they could be in various positions in the pelvic and abdominal cavity,and pelvic region was most common in 52 cases(60.5%).Peritoneal loose bodies were found to be up to 20 cm in diameter,but usually ranged from 1 cm to 10 cm in length.In conclusion,departments related to abdominal surgery(general surgery,urology,obstetrics and gynecology,etc.)should pay attention to the clinical manifestations,diagnosis and treatment of peritoneal loose bodies to avoid the damage caused by misdiagnosis.