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病例报告与文献综述:55岁特发性肠系膜静脉硬化患者的腹腔镜扩大右半结肠切除术

Case report and literature review: Laparoscopic extended right hemicolectomy for a 55-year-old patient with idiopathic mesenteric phlebosclerosis.

作者信息

Liu Siyu, Tong Yujun, Shi Ruizi, Zeng Xintao, Luo Hua, Yang Pei, Cai Xianfu, Wang Decai, Luo Huiwen, Wang Jianjun

机构信息

Department of Breast Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.

Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.

出版信息

Front Med (Lausanne). 2024 Jul 16;11:1382475. doi: 10.3389/fmed.2024.1382475. eCollection 2024.

Abstract

Idiopathic mesenteric phlebosclerosis (IMP) is an extremely rare disease with an unclear pathogenesis and risk factors. The clinical manifestations of IMP are mostly non-specific, mainly consisting of digestive symptoms such as abdominal pain, bloating and diarrhea. The diagnosis of IMP mainly relies on abdominal computed tomography (CT) and colonoscopy. Pathological changes associated with IMP often involve fibrous degeneration of the venous wall, which results in the thickening of the colonic wall and longitudinal calcification of the mesenteric arteries. Currently, there is no standard treatment protocol for IMP, and nonsurgical treatment is the mainstay of most medical centers. In this study, we reported a case of a 55-year-old female patient with IMP whose main clinical presentation was recurrent abdominal pain. The patient's initial diagnosis was considered an incomplete intestinal obstruction and received non-surgical treatments; however, the efficacy of the treatment was unsatisfactory. After completing abdominal CT and colonoscopy, we excluded common diseases of the digestive system (e.g., tumors, Crohn's disease), and finally considered that this patient had a high likelihood of IMP. This patient eventually underwent laparoscopic enlarged right hemicolectomy due to recurrent symptoms and poor outcomes of non-surgical treatment. Postoperative pathological results confirmed the diagnosis of IMP. During the follow-up period, the patient recovered well without recurrence of IMP. Furthermore, we have reviewed the literature related to IMP and summarized the etiology, risk factors, diagnostic methods, treatment options and prognosis of IMP.

摘要

特发性肠系膜静脉硬化(IMP)是一种极为罕见的疾病,其发病机制和危险因素尚不清楚。IMP的临床表现大多不具特异性,主要包括腹痛、腹胀和腹泻等消化系统症状。IMP的诊断主要依靠腹部计算机断层扫描(CT)和结肠镜检查。与IMP相关的病理变化常涉及静脉壁的纤维变性,这会导致结肠壁增厚和肠系膜动脉纵向钙化。目前,IMP尚无标准治疗方案,非手术治疗是大多数医疗中心的主要治疗方式。在本研究中,我们报告了一例55岁女性IMP患者,其主要临床表现为反复腹痛。该患者最初被诊断为不完全性肠梗阻并接受了非手术治疗;然而,治疗效果并不理想。在完成腹部CT和结肠镜检查后,我们排除了消化系统常见疾病(如肿瘤、克罗恩病),最终认为该患者极有可能患有IMP。由于症状反复且非手术治疗效果不佳,该患者最终接受了腹腔镜扩大右半结肠切除术。术后病理结果证实了IMP的诊断。在随访期间,患者恢复良好,IMP未复发。此外,我们查阅了与IMP相关的文献,并总结了IMP的病因、危险因素、诊断方法、治疗选择和预后。

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