小儿Meckel憩室腹腔镜下分型与术式选择的研究

Research on the type and surgical options of pediatric laparoscopic Meckel diverticulum

目的探讨小儿Meckel憩室腹腔镜下分型及根据分型选择采用完全腹腔镜或腹腔镜辅助Meckel憩室切除肠吻合术的可行性。方法回顾性分析该院2010年1月～2013年1月采用腹腔镜诊断治疗的55例有临床症状的Meckel憩室临床资料。结果根据腹腔镜下Meckel憩室的形态,41例为单纯型,14例为复杂型。41例单纯型Meckel憩室完全腹腔镜下行Meckel憩室切除肠吻合术,14例复杂型Meckel憩室经脐腹腔镜辅助经延长脐部切口将憩室提出腹腔外行Meckel憩室切除及邻近肠切除肠吻合术。41例完全腹腔镜手术时间29～78 min,平均（38.85±9.75）min,14例腹腔镜辅助手术时间45～123 min,平均（54.57±20.17）min。术后第5天开始进食流质,术后第7天出院。结论 Meckel憩室腹腔镜下可分为单纯型和复杂型,根据临床分型选择采用完全腹腔镜或经脐腹腔镜辅助Meckel憩室切除肠吻合术,是诊断治疗小儿Meckel憩室安全、可行且有效的方法之一。

【Objective】To evaluate the feasibility of totally or hand-assisted laparoscopic Meckel＇s diverticulectomy and laparoscopic enteroenterostomy according to the type of laparoscopic Meckel diverticulum.【Methods】The clinical data of 55 cases of Meckel＇s diverticulum admitted between January 2010 and January 2013 were analyzed.【Results】According to the laparoscopic appearance, Meckel＇s diverticulum was divided into simplex（n=41）and complex（n =14）. As a result, totally laparoscopic surgery was performed in 41 simplex cases, laparoscopic-assisted resection in 14 complex cases by extending the navel incision and pulling the diverticulum out of the abdominal cavity. And the operation time was 29～78 min（38.85±9.75） min and 45～123 min（54.57±20.17） min, respectively. All of the patients started eating liquid 5 days and discharged 7 days after surgery. 【Conclusion】According to the laparoscopic appearance, Meckel＇s diverticulum can be divided into simplex and complex. According to the types of laparoscopic Meckel diverticulum, totally and hand-assisted laparoscopic Meckel＇s diverticulectomy and laparoscopic enteroenterostomy, is safe, feasible and effective for the diagnosis and treatment of Meckel＇s diverticulum in children.