肠道脂肪瘤诊治的体会
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罗蒙

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Diagnosis and treatment of intestinal lipoma 
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    摘要:

    目的:分析肠道脂肪瘤的主要临床特点,探讨其诊治方法。
    方法:回顾性分析近15年间收治的19例肠道脂肪瘤的临床资料,诊断主要依赖于CT,钡剂灌肠,超声内镜和结肠镜等。治疗主要采用开腹和腹腔镜下局部肠段切除术等外科手术方法。
    结果:该病的临床表现无特异性。发现症状时,除2例患者无症状外,其余17例肠道脂肪瘤患者均以排便习惯改变,腹痛,便血为主诉。其中13例术前术中伴有肠套叠或肠梗阻。16例行结肠镜等辅助检查者中,7例明确诊断。17例患者行外科手术治疗,术中见脂肪瘤大小直径为3.0~6.5 cm,术后均痊愈。术后病理检查显示12例为黏膜下脂肪瘤,2例溃疡形成伴糜烂,2例为肌壁间脂肪瘤,1例为小肠不典型脂肪瘤,伴恶性潜能。2例经结肠镜活检明确诊断者因无症状而定期随访。
    结论:影像学检查和结肠镜检查有助于肠道脂肪瘤的术前诊断。根据肿瘤大小、有蒂或无蒂及其临床表现选择治疗方式,肠道脂肪瘤的治疗以局部肠道切除术为主,内镜下小于3 cm带蒂肿瘤可行经内镜电切术。

    Abstract:

    Objective:To analyze the main clinical manifestations of intestinal lipoma and discuss the treatment of intestinal lipoma.
    Methods :The clinical data of 19 patients with intestinal lipoma treated in our hospital in recent 15 years were analyzed retrospectively. CT, ultrasonography, and colonoscopy were used in diagnosis. Local intestinal resection by laparoscopy and laparotomy were employde.
    Results:Intestinal lipoma presented with a variety of symptoms including intestinal bleeding,abdominal pain,anemia,intussusception,and bowel obstruction. In 17 of the intestinal lipoma patients, the main clinical manifestations were change of  bowel habits, abdominal pain and bloody stool; 13 of them had intestinal intussusception or obstruction,  and two patients were asymptomatic. Sixteen patients underwent colonoscopy,and seven of them were correctly diagnosed.Seventeen patients received surgical resection and recovered.The diameter of mass was 3-6.5 cm. The pathologic exam showed submucosal lipoma in 12 cases, two cases showed ulcer formation with erosion, 2 cases had intermural lipoma and one case had atypical lipoma with potential  malignant transformation.Two asymptomatic patients diagnosed by colonoscopic biopsy werre only followed up at regular intervals.
    Conclusions:Imaging diagnosis and colonoscopy are helpful in the preoperative diagnosis of intestinal lipoma.The method of treatment is based on the size of the tumor and presence or absence of pedicle. Endoscopic electrosection is often used for tumor mass less than 3 cm in diameter, otherwise local intestinal resection is the treatment of chocie.

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刘晔, 徐庆, 罗蒙.肠道脂肪瘤诊治的体会[J].中国普通外科杂志,2009,18(9):951-954.
DOI:10.7659/j. issn.1005-6947.2009.09.017

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  • 收稿日期:2009-05-22
  • 最后修改日期:2009-07-21
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  • 在线发布日期: 2009-09-15