摘要
目的分析以急腹症为首发症状的小儿肠系膜淋巴管瘤的诊治特点。方法回顾性分析2008年6月至2014年6月间收治的15例以急腹症为首发症状，最后经病理检查证实为肠系膜淋巴管瘤患儿的临床资料。结果15例患儿中，男女比为4：1，平均年龄3．9岁，无外伤史，部分发病前有饮食过量并剧烈运动的可疑诱因，均以急腹症就诊。腹痛史3h～3年不等。本组门、急诊诊断准确率为26．7％（4／15），彩色超声诊断准确率为86．6％（13／15），CT检查诊断准确率为93．3％（14／15）。所有病例均通过手术探查及病理诊断证实为肠系膜淋巴管瘤。其中肿瘤位于小肠系膜9例，结肠系膜6例。囊液清亮4例，乳糜样液体3例，血性液体8例。4例行完整的肿瘤剔除，6例部分剔除，5例连同累及肠管一并切除。全部患儿行彩色超声随访半年未见复发及粘连性肠梗阻发生，60％（9／15）随访3年以上未见复发。结论肠系膜淋巴管瘤是一种临床少见的淋巴管先天性发育异常，缺乏特异性临床症状和体征，误诊及漏诊率高。对反复出现腹痛、腹胀的患儿应警惕患该病可能。彩色超声和CT检查对诊断帮助大，手术是有效的治疗手段，病理检查是诊断该病的金标准。
Objective To explore the characteristics and prognosis of mesenteric lymphangioma （ML） presenting as acute abdomen in children. Methods A total of 15 hospitalized patients with acute abdomen were analyzed retrospectively. Results The male-to-female ratio was 1 1 ： 14. Their median age at diagnosis was 3. 9 years. The common symptom was abdominal pain with a duration of hours or years. Two cases had hyperphagia and heavy exercise prior to hospitalization＊ No trauma history was reported. And 26. 7% （4/15） of patients were accurately diagnosed as ML in emergency and outpatient departments, 86.6% （13/15） abdominal ultrasound and 93.3% （14/15） computed tomography （CT）. ML was confirmed by pathologic examination. ML was located in mesentery of small intestine （n = 9） and mesocolon （n = 6）. Cyst fluid was clear （n = 4）, chylous （n = 3） and bloody （n = 8）. The procedures included complete tumor removal （n = 4）, partial 6 removed partly, 5 excised with intestinal resection involved. Neither recurrence nor adhesive intestinal obstruction occurred during a 6-month follow-up period. And 60% （9/15） had no recurrence at 3 years post- operation. Conclusions ML is a rare benign developmental anomaly of lymphatics without obvious clinical symptoms and physical examination. There are high rates of misdiagnosis and missed diagnosis. Recurrent abdominal pain and distension deserve more attention. Ultrasonography and CT scan may aid the diagnosis. The major therapeutic modality is surgery with a decent postoperative prognosis.
出处
《中华小儿外科杂志》
CSCD
2016年第6期444-448,共5页
Chinese Journal of Pediatric Surgery
关键词
淋巴管瘤
肠系膜囊肿
急腹症
误诊
Lymphangioma
Mesenteric cyst
Abdomen, acute
Diagnostic errors
