小肠淋巴管瘤临床分析

摘要

目的：提高临床医师对小肠淋巴管瘤的认识。方法对我院1例及文献报道的33例小肠淋巴管瘤患者的临床资料进行综合分析。结果男女比例1.27∶1,年龄4 d~65岁,其中≤18岁13例,18~45岁17例,45~65岁4例。中位病程0.9个月( Q=10.37个月),其中以急性病程(≤1个月)为主,共23例(67.6%),中位病程6 d(Q=28 d),慢性病程(>1个月)11例(32.4%),中位病程24个月(Q =98个月)。病变分布方面,十二指肠及空回肠13例(38.2%),肠系膜受累16例(47.1%),回盲部5例(14.7%)。临床表现方面,10/13例十二指肠及空回肠淋巴管瘤表现为消化道出血；肠系膜淋巴管瘤主要表现为腹痛(13/16例),恶心、呕吐(7/16例),肠梗阻发生率高(4/16例),多因急腹症就诊；回盲部淋巴管瘤也易出现急腹症(4/4例)。影像学检查对小肠淋巴管瘤缺乏准确性,胶囊内镜与小肠镜弥补了这一不足。治疗方面,32/34例接受手术治疗,包括急腹症开腹探查术,其中1例术后3d死亡。结论小肠淋巴管瘤极为罕见,临床表现缺乏特异性,胶囊内镜与单气囊小肠镜有助于诊断,确诊后应积极手术治疗,预后良好。%Objective To improve the recognition of small bowel lymphangioma among physicians. Methods The clinical data of a patient with small bowel lymphangioma in our hospital and other 33 cases followed by a review of litera-ture were collected and analyzed. Results Male/female ratio was 1. 27∶1, ages from 4 days to 65 years old, 13 patients≤18 years, 17 patients from 18 to 45 years, 4 patients from 45 to 65 years. The median duration of disease was 0. 9 months (Q=10. 37 months). 23 cases (67. 6%) were acute process, whose median duration was 6 days (Q =28 days), while the rest were chronic process, whose median duration was 24m (Q=98 months). The distribution of le-sions were 13/34 duodenum and jejuno-ileum ( 38 . 2%) , 16/34 mesentery involved and 5/34 ileocecal junction (14. 7%). Lesions located in duodenum and jejuno-ileum often presented as gastrointestinal hemorrhage. Mesentery in-volved patients often complained about abdominal pain, nausea and vomiting. There was a high percentage of intestinal obstruction in these cases. Ileocecal lesions also presented as acute abdomen. Radiography had a limitation in diagnosis of small bowel diseases, while capsule endoscopy and small bowel endoscopy made the compensation. 32/34 cases un-derwent surgery, including exploratory procedures. 1 case died 3 days after the surgery. Conclusion Lymphangioma in small intestine is rare, while specific clinical presentation is absent. Capsule endoscopy and single-balloon enteroscopy are valuable assistant examination, which compensate the defect of traditional imaging examination. Surgery is the first choice of treatment,and patients will have a favorable prognosis.