腹茧症是一种罕见的腹部疾病,病因尚未明确,主要表现为腹腔部分或全部脏器被一层纤维膜包裹,行似蚕茧。本病诊断较为困难,多数为术中发现,CT对诊断有帮助。手术是确诊及有效治疗主要手段。腹茧症会导致生育期女性不孕症,可行IVF-ET助孕。对于合并腹茧症患者的分娩方式建议阴道分娩,如有指证也可行剖宫产,注意术前评估手术难度,做好术中术后抢救工作。 Abdominal cocoon is a rare abdominal disease, the etiology is not clear, mainly manifested as part or all of the abdominal organs are wrapped by a layer of fibrous membrane, like cocoon. This dis-ease is difficult to diagnose, mostly found during surgery, CT is helpful for diagnosis. Operation is the main means of diagnosis and effective treatment. Abdominal cocoon can lead to infertility in women in reproductive period, and IVF-ET is feasible to assist pregnancy. For patients with ab-dominal cocoon, vaginal delivery is recommended, if there is evidence, cesarean section is also fea-sible, pay attention to preoperative evaluation of surgical difficulty, and do a good job of intraopera-tive and postoperative rescue work.
腹茧症是一种罕见的腹部疾病,病因尚未明确,主要表现为腹腔部分或全部脏器被一层纤维膜包裹,行似蚕茧。本病诊断较为困难,多数为术中发现,CT对诊断有帮助。手术是确诊及有效治疗主要手段。腹茧症会导致生育期女性不孕症,可行IVF-ET助孕。对于合并腹茧症患者的分娩方式建议阴道分娩,如有指证也可行剖宫产,注意术前评估手术难度,做好术中术后抢救工作。
腹茧症,不孕,剖宫产
Huidan Guo, Hongying Dai*
The Affiliated Hospital of Qingdao University, Qingdao Shandong
Received: May 10th, 2022; accepted: May 27th, 2022; published: Jun. 13th, 2022
Abdominal cocoon is a rare abdominal disease, the etiology is not clear, mainly manifested as part or all of the abdominal organs are wrapped by a layer of fibrous membrane, like cocoon. This disease is difficult to diagnose, mostly found during surgery, CT is helpful for diagnosis. Operation is the main means of diagnosis and effective treatment. Abdominal cocoon can lead to infertility in women in reproductive period, and IVF-ET is feasible to assist pregnancy. For patients with abdominal cocoon, vaginal delivery is recommended, if there is evidence, cesarean section is also feasible, pay attention to preoperative evaluation of surgical difficulty, and do a good job of intraoperative and postoperative rescue work.
Keywords:Abdominal Cocoon, Infertility, Cesarean Delivery
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腹茧症是一种罕见的腹部疾病,因表现为腹部部分或全部脏器被一层一层致密、灰白色质韧、硬厚的纤维膜,行似蚕茧而得名。其确切的发病原因和发病机制尚不清楚,有多种学说:① 女性生殖道逆行感染;② 异物刺激;③ 先天性畸形;④ 药物影响;⑤ 病毒感染。我科于2021年8月收治1例腹茧症患者,并行急症剖宫产,现报道如下:
患者26岁,孕1产0,孕39周,因胎膜早破于2021年8月22日入院。患者24岁结婚,既往体健,无手术史,未避孕未孕1年,男方精液常规无异常,行超声示:右附件区见7.0 × 5.2 cm弯曲管状回声,管壁不光整。左附件区见5.7 × 3.5 cm弯曲管状回声,管壁不光整,考虑输卵管积水。于2019年12月20日于我院妇科就诊行腹腔镜探查 + 宫腔镜检查 + 通液术。宫腔镜下见:宫颈管形态正常,宫腔形态正常,子宫内膜中厚,双侧输卵管开口可见。腹腔镜下见:通液示可顺畅通入亚甲蓝液体40 m。腹腔内遍布膜样组织,左下腹与肠管多层广泛膜状物,无法查见子宫及双侧输卵管卵巢,大网膜与上腹部腹壁黏连,上腹部均为腹膜样组织,无法查见肝脏等器官。术中分离部分腹膜样组织仍无法探查子宫及双侧输卵管卵巢,考虑患者为腹茧症,向患者家属交代病情,手术无法进行,建议直接于生殖科行辅助生殖。患者2020年12月10日于我院生殖科移植囊胚一枚。此次因“孕39周 胎膜早破”入院,入院时查体:T:36.5℃ P:60次/分 R:17次/分 BP:115/70 mmHg 心肺听诊无异常,肝脾未扪及,脊柱四肢无畸形。宫高36 cm,腹围102 cm,胎方位左枕前,胎心率142次/分,宫颈质中,居中,容受80%,先露头,S-1,宫口容指,胎膜破,宫颈评分7分。患者骨盆测量无明显异常,估计胎儿体重3500 g大小,可经阴试产。试产过程中出现多次晚期减速,遂因胎儿窘迫在椎管内麻醉下行急症剖宫产术,取耻骨联合上二横指横行切口约15 cm术中见:子宫左侧壁、右侧壁、宫底均与腹膜粘连,无法进入腹腔内,遂行腹膜外剖宫产术。取子宫下端膀胱反折腹膜处横行切开子宫全肌层长约2 cm。刺破羊膜见:羊水III度污染,量约300 ml,质地稀薄,负压吸净羊水后,钝性弧形向两侧延长切口长约10 cm。以LOA位娩出一外观无畸形女婴,体重3300 g,Apgar评分10分。胎儿娩出后发现部分胎盘植入较深,予手取胎盘,术中出血2500 ml,输注血浆1000 ml,红细胞3.5单位,冷沉淀10国际单位,血小板1个治疗量,给予纱布卷宫腔填塞,多处缝扎止血。术后转入ICU,给予输注红细胞7.5单位、补充白蛋白、利尿、邦达抗感染等治疗,病情平稳后转回产科,后继续予以监测生命体征、抗凝、药物口服补血、抗感染、益母草胶囊促子宫收缩等治疗。术后恢复良好,术后3天排气排便,术后5天出院,母婴均安,术后随访半年,无腹痛、腹胀等不适,恢复良好。
腹茧症是一种罕见的腹膜良性疾病,1978年Foo等首先报道并正式命名为腹茧症 [
腹茧症常无特异性临床表现和实验室诊断指标,常以腹部包块或不全肠梗阻为首发症状,病情进展严重者可有腹痛、腹胀、呕吐等急性或慢性肠梗阻等症状,术前诊断困难,多为手术时发现。影像学检查在本病诊断中具有重要价值,X线仅能显示肠梗阻的征象,CT已成为首选检查方法,CT能够更好地显示梗阻的程度及包块内折叠的小肠,能直接显示类似茧样包裹在肠管周围的纤维包膜,此结构是CT诊断腹茧症最直接、最重要的特征征象 [
腹茧症治疗方法应根据患者病情决定。对于无症状或症状较轻微者因其他疾病在检查时诊断的腹茧症,由于其包裹均匀、对称、致密,包裹的脏器无移位,可不予处理或保守治疗;对于存在梗阻症状或出现腹部包块的患者,手术治疗是治疗腹茧症最有效的手段 [
腹茧症容易造成妇科患者不孕,李云云等 [
对于合并腹茧症患者的分娩方式建议阴道分娩,以降低手术时进腹困难及增加腹腔粘连概率,但如有指征也可行剖宫产术 [
腹茧症是一种罕见的腹部疾病,病因尚未明确。本病诊断较为困难,多数为术中发现。手术是确诊及有效治疗主要手段。腹茧症会导致生育期女性不孕症,可行IVF-ET助孕。对于合并腹茧症患者的分娩方式建议阴道分娩,如有指证也可行剖宫产,剖宫产难度较大,风险较高。临床医生应充分了解腹茧症,术中做到灵活处理,必要时可请相关科室协助。
郭慧丹,戴红英. 腹茧症行急症剖宫产1例并文献复习One Case of Acute Cesarean Section for Abdominal Cocoon and Review of Literature[J]. 临床医学进展, 2022, 12(06): 5156-5159. https://doi.org/10.12677/ACM.2022.126747