Li Sheng, Wang Jun-Jiang, Hu Wei-Xian, Zhang Mou-Cheng, Liu Xian-Yan, Li Yong, Cai Guan-Fu, Liu Sen-Lin, Yao Xue-Qing
Southern Medical University, Guangzhou, China.
Department of Gastrointestinal Surgery, Central Hospital of Shaoyang, Shaoyang, Hunan, China.
World J Surg. 2017 May;41(5):1287-1294. doi: 10.1007/s00268-016-3855-9.
Abdominal cocoon (AC) is a rare abdominal disease with nonspecific clinical features, and it is difficult to be diagnosed before operation and hard to be treated in clinical practice. The aim of this study is to investigate the diagnosis and treatment of AC.
The clinical manifestations, findings during surgery, treatments, and follow-up results of 26 cases of AC were retrospectively studied from January 2001 to January 2015.
All of 26 cases were diagnosed as AC definitely by laparotomy or laparoscopic surgery. Their clinical findings were various, with 7 intestines obstructed with bezoars and 4 intestines perforated by spiny material. Based on the existence of the second enterocoelia, all cases were categorized into 2 types: type I is absent of second enterocoelia (18 cases, 69.23%), while type II shows second enterocoelia (8 cases, 30.77%). Twenty cases (12 were type I and 8 were type II) underwent membrane excision and careful enterodialysis to release the small intestine entirely or partially, while the other 6 cases (all were type I) did not. In addition, all patients were treated with medical treatment and healthy diet and lifestyle. Finally, most of the patients recovered smoothly.
AC can be categorized into two types; surgery is recommended for type II and part of type I with severe complications, but sometimes conservative therapy might be appropriate for type I. Laparoscopic surgery plays an important role in the diagnosis and treatment of AC. Furthermore, favorite health education, healthy diet and lifestyle are of significance in patients' recovery.
腹茧症（AC）是一种临床特征不典型的罕见腹部疾病，术前诊断困难，临床治疗棘手。本研究旨在探讨腹茧症的诊断与治疗方法。
回顾性分析2001年1月至2015年1月收治的26例腹茧症患者的临床表现、手术所见、治疗方法及随访结果。
26例均经剖腹手术或腹腔镜手术确诊为腹茧症。临床表现多样，其中7例肠管内有粪石梗阻，4例肠管被棘状物穿孔。根据有无第二腹腔，将所有病例分为两型：Ⅰ型无第二腹腔（18例，69.23%），Ⅱ型有第二腹腔（8例，30.77%）。20例（Ⅰ型12例，Ⅱ型8例）行包膜切除及仔细的肠粘连松解术，使小肠完全或部分松解，其余6例（均为Ⅰ型）未行手术。此外，所有患者均接受药物治疗及健康的饮食和生活方式指导。最终，大多数患者恢复顺利。
腹茧症可分为两型；Ⅱ型及部分有严重并发症的Ⅰ型建议手术治疗，但Ⅰ型有时保守治疗可能更合适。腹腔镜手术在腹茧症的诊断和治疗中发挥着重要作用。此外，良好的健康教育、健康的饮食和生活方式对患者的康复具有重要意义。
