肠系膜器官:解剖学概念及相关疾病研究进展

将肠系膜分类为一个器官的提议促使临床医生和放射科医生重新认识肠系膜疾病及评估治疗方法。肠系膜解剖学的最新进展和对其结构的更好理解构成了推进疾病治疗进程的基础,并允许开发较少的根治性(包括内镜、放射学和药物治疗)治疗方法。基于肠系膜的影像学评估是相关疾病放射学干预和术后监测计划的重要组成部分。本文旨在阐述肠系膜相关解剖学概念的更新,并将肠系膜疾病分为原发性和继发性病变进行简要叙述。

腹腔镜次全子宫切除缝与不缝腹膜的对比研究

目的探讨腹腔镜次全子宫切除术是否需要缝合腹膜。方法取106例子宫良性病变行腹腔镜次全子宫切除的患者,分为不缝腹膜组(观察组)和缝腹膜组(对照组)。对比两组患者手术时间、术中出血量、术后短期疗效和长期预后的随访情况。结果观察组手术时间、住院费用少于对照组,差异有统计学意义(P<0.05)。结论在相同疗效的前提下,不缝腹膜减少了手术操作及麻醉时间,减少了患者麻醉风险及住院费用,医患双方均能获益。

急性穿孔性腹膜炎的CT诊断

目的探讨急性胃肠道穿孔继发腹膜病变的CT表现,提高对穿孔性腹膜炎的影像学诊断与鉴别能力。方法对36例拟诊穿孔性腹膜炎患者行CT扫描,着重观察与腹膜炎相关的6种CT征象并作出术前诊断,其中28例在CT扫描后24小时内手术,并经手术和病理证实穿孔性腹膜炎的部位及程度,8例经临床综合指标明确诊断;分别计算与穿孔性腹膜炎相关的6种CT征象诊断的敏感度,特异度及正确率,术前CT诊断与临床手术病理对照采用相关系数法检验。结果术前综合运用主要CT征象对穿孔性腹膜炎的正确诊断率为86.1%(31/36),穿孔性腹膜炎的主要CT表现为腹腔游离气体影、腹腔积液、胃肠道壁增厚、壁腹膜增厚、肠系膜条纹征、肠郁张,其敏感度分别为82.1%、92.8%、67.8%、75%、89%、53.6%,特异度为25%、37.5%、62.5%、100%、89.3%、75%,腹腔积液、壁腹膜增厚、肠系膜条纹征与腹膜炎诊断有显著相关性(P<0.05)。结论根据CT征象可在术前对穿孔性腹膜炎做出较为准确的诊断。

Peritoneal cavernous hemangiomatosis:A case report

BACKGROUND Cavernous hemangiomatosis in the liver and spleen has been reported, but it occurs less commonly in the peritoneum. Here we report a case of peritoneal cavernous hemangiomatosis and share some valuable information about this disease.CASE SUMMARY A 57-year-old Chinese man had a huge abdominal mass with abdominal distention and a significant reduction of food consumption. An enhanced abdominal and pelvic computed tomography and positron emission tomography–computed tomography revealed multiple cystic masses on the peritoneum, greater omentum, small intestinal mesentery and the surface of the spleen, and a high maximum standardized uptake value of the largest cystic lesion. Exploratory laparotomy was performed, and multiple cystic masses were found on the surface of the peritoneum, greater omentum, mesentery of the small intestine, and surface of the liver and spleen. Dark red bloody cystic fluid was present in the cystic tumor. Pathological examination showed that in the stromal components, the irregular vascular wall was thin. The vessel lumen was interlinked, and the lumen was lined with flat endothelium. According to the intraoperative findings and pathologic results, the patient was diagnosed with peritoneal cavernous hemangiomatosis.CONCLUSION The possibility of peritoneal cavernous hemangiomatosis should be considered when multiple cystic masses are found in the abdominal cavity by preoperative examination.

E-钙粘附素在子宫内膜异位症盆腔腹膜病灶的表达

目的通过观察E-钙粘附素在不同的盆腔腹膜内膜异位病灶的表达情况,研究其表达规律。方法采用病理光镜,免疫组化EnVision法检测腹腔镜下诊断盆腔腹膜子宫内膜异位病灶45例及正常对照组36例,了解其中的E-钙粘附素表达情况。结果E-钙粘附素的表达水平在白色病变较红色病变和褐色病变为低,差异有显著性(P<0.05)。结论E-钙粘附素的表达水平可能与病灶的范围、深度、患病时间久暂呈正相关。