小儿Littre疝临床特点分析

Clinical characteristics of Littre hernia in children

目的总结小儿Littre疝的临床特点及治疗经验。方法回顾性分析2002年1月至2010年12月11例Littre疝的临床资料。结果11例均为男孩，Littre疝均为术中发现，中位年龄1．2岁。临床特征：腹股沟区疼痛性形状不规则不可复性肿块11例，呕吐6例，发热4例（≥38．5℃）；X线平片显示肠梗阻9例；B超发现腹股沟区混合性包块11例，其中发现疝内容物中含囊袋样结构6例；实验室检查8例患儿白细胞升高（〉10000）。手法复位困难，有疝内容物还纳不尽感，5例可触及分叶状结构。11例Littre疝患儿均顺利完成手术，Meckel憩室穿孔者2例，无穿孔9例；Meckel憩室与疝囊粘连者8例（8／11），未粘连3例。患儿术后均痊愈出院，术后随访时间10个月至8年，无一例复发。结论小儿Littre疝临床罕见，术前诊断困难，术中避免损伤Meckel憩室或肠管等方法是提高小儿Littre疝治愈率的关键。

Objective To investigate the clinical features of pediatric Littre hernia. Methods Clinical data of 11 cases of Littre hernia admitted from January 2002 to December 2010 was studied retrospectively. Results The diagnosis of Littre hernia was all established by laparotomy. All of the 11 cases were boys,the median age was 1.2 years （22 days to 3 years and 7 months）. The main clinical features were： painful, irregular and nonresetable mass in the groin area （11/11）, vomiting in 6 cases （6/11）, fever （ ≥38.5 ℃ ） in 4 cases （4/11） ; X-ray showed intestinal obstruction in 9 cases（9/ll ）, Ultrasound found mixed mass in the groin area in 11 cases （11/11）, pouch-like structure were found in 6 cases （6/11）. Eight cases （8/11） presented with elevated WBC （ 〉 10 000）. Palpable lobulated structure were felt in 5 cases （ 5/11 ）. All cases of Littre hernia were successfully operated on, Meckel diverticulum perforation was found in 2 cases （2/11）, Meckel diverticulum adhered to the hernia sac in 8 cases （8/11）. All patients were cured by surgery, and postoperative follow-up （10ms -8y） found no recurrence. Conclusions Pediatric Littre hernia is rare, preoperative diagnosis is difficult. Avoiding preoperative violent reduction and intraoperative injuring Meckel＇s diverticulum or the small bowel helps improve the cure rate of Littre hernia in children.