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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1 5年间收治的1 9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1 7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1 3例术前术中伴有肠套叠或肠梗阻。1 6例行结肠镜等辅助检查者中,7例明确诊断。1 7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1 2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。
Objective To analyze the main clinical features of intestinal lipoma and to explore its diagnosis and treatment. Methods The clinical data of 19 cases of intestinal lipoma treated in the recent 15 years were retrospectively analyzed. The diagnosis mainly depends on CT, barium enema, endoscopic ultrasound and colonoscopy. The main treatment of laparotomy and laparoscopic partial bowel resection and other surgical methods. Results The clinical manifestations of the disease is not specific. Found symptoms, in addition to 2 patients without symptoms, the remaining 17 cases of intestinal lipoma patients are changing bowel habits, abdominal pain, blood in the main complaint. Among them, 13 cases had intussusception or intestinal obstruction during the operation. Sixteen routine colonoscopy and other auxiliary examiners, 7 cases of a clear diagnosis. Seventeen patients underwent surgical treatment. During the operation, lipoma size was 3.0-6.5 cm in diameter and recovered after operation. Postoperative pathological examination revealed 12 cases of submucosal lipoma, 2 cases of ulceration with erosion, 2 cases of intramuscular lipoma, and 1 case of small-bowel atypical lipoma with malignant potential. Two cases confirmed by colon biopsy were asymptomatic because of regular follow-up. Conclusions Imaging and colonoscopy contribute to the preoperative diagnosis of intestinal lipoma. According to tumor size, pedicle or pedicle and its clinical manifestations of choice treatment, the treatment of intestinal lipoma local gastrectomy, endoscopic less than 3 cm pedunculated tumor via endoscopic electrotomy.