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目的探讨小儿结肠系膜淋巴管瘤的诊断与治疗方法。方法回顾性分析我院2006年1月至2011年12月期间手术治疗的5例小儿结肠系膜淋巴管瘤的临床资料。结果 3例诊断为腹腔包块性质待查的患儿,术中发现腹腔肿块来源于乙状结肠系膜,其中1例肿块侵犯到降结肠系膜达结肠脾曲而行左半结肠切除+肠吻合术,另外2例行乙状结肠系膜淋巴管瘤切除+部分乙状结肠切除+肠吻合术;1例患儿诊断为急性化脓性阑尾炎合并乙状结肠系膜淋巴管瘤,行阑尾切除+乙状结肠系膜淋巴管瘤切除+肠吻合术,1例患儿诊断为乙状结肠系膜淋巴管瘤破裂并弥漫性腹膜炎,行乙状结肠系膜淋巴管瘤切除+乙状结肠造瘘术,术后6个月后再行二期手术。5例患儿手术后恢复良好,未发生吻合口漏等并发症。术后随访5个月～5年,(2.3±1.1)年,1例失访,余均存活,仍在随访中,所有病例均未复发。结论日常行阑尾手术中,应常规探查小肠、结肠;未进行肠道准备的结肠一期吻合手术中结肠灌洗可减少吻合口漏等并发症的发生率;腹腔感染严重的患儿结肠一期吻合不可取,结肠造瘘安全;小儿结肠系膜淋巴管瘤术前确诊困难,反复出现腹痛、腹部包块的患儿应想到结肠系膜淋巴管瘤的可能性,行充分的肠道准备后择期手术,手术是肠系膜淋巴管瘤唯一的治疗方法。
Objective To investigate the diagnosis and treatment of pediatric mesenteric lymphangioma. Methods The clinical data of 5 cases of pediatric mesenteric lymphangioma treated surgically in our hospital from January 2006 to December 2011 were retrospectively analyzed. Results Three cases were diagnosed as children with peritoneal mass to be examined. Intraperitoneal lumps were found in sigmoid mesangioma, of which 1 case had a mass invasion to the descending mesocolon up to the colon splenic flexion and the left half colon resection plus intestinal anastomosis, Another 2 cases of sigmoid mesangial lymphangioma resection + part of the sigmoid colon resection + intestinal anastomosis; 1 case of children diagnosed with acute suppurative appendicitis combined with mesangial lymphangioma, appendectomy + sigmoid mesangial lymphangioma + Intestinal anastomosis, one case of children diagnosed as sigmoid mesangial lymphangioma ruptured and diffuse peritonitis, line sigmoid mesangial lymphangioma resection + sigmoidostomy, after 6 months after the second phase of surgery. 5 cases of children recovered well after surgery, no complications such as anastomotic leakage occurred. The patients were followed up for 5 months to 5 years (2.3 ± 1.1) years and 1 patient lost their follow-up. All patients were still under follow-up. No recurrence was found in all cases. Conclusion In routine operation of the appendix, small intestine and colon should be probed routinely. Colonic lavage during primary anastomosis of the colon without intestinal preparation can reduce the incidence of complications such as anastomotic leakage. In patients with severe intraperitoneal infection, Anastomosis undesirable colonic fistula safety; Pediatric mesenteric lymphangioma preoperative diagnosis difficult, recurrent abdominal pain, abdominal mass in children should think of the possibility of mesangial lymphangioma, the line of adequate bowel preparation after elective surgery , Surgery is the only treatment of mesenteric lymphoma.