135例小儿梅克尔憩室临床及病理特征分析

Clinical and pathologic feature of 135 cases with Meckel′s diverticulum in children

目的分析小儿梅克尔憩室的临床表现和病理特征。方法回顾性分析该院2011年1月至2013年9月收集的135例梅克尔憩室患儿的临床和病理资料。结果 135例患儿消化道症状分别为呕吐92例(68.1%),血便63例(46.7%),腹痛59例(43.7%)。在49例行肛诊检查患儿中,20例肛诊引出果酱样大便,5例引出红色血便,11例引出黄色大便和气体,13例未引出大便。临床并发症分别为肠梗阻86例(63.7%),消化道出血62例(45.9%),急性憩室炎49例(36.3%),急性肠套叠39例(28.9%),肠坏死25例(18.5%),急性弥散性腹膜炎16例(11.9%),急性阑尾炎15例(11.1%)。35例99mTcO4-胃黏膜异位核素显像阳性患儿术中见梅克尔憩室。135例患儿术中见梅克尔憩室且行病理组织学检查,病理诊断全部为梅克尔憩室,胃黏膜上皮异位,可伴憩室感染并出血坏死、溃疡形成、慢性阑尾炎、肠出血坏死、局灶性腹膜炎、胰腺组织。结论小儿梅克尔憩室以呕吐、血便和腹痛为主要临床症状。梅克尔憩室常随着并发症的发生而出现症状,99mTcO4-胃黏膜异位核素显像有助于梅克尔憩室病变的诊断。

Objective To analyze the clinical and pathologic characteristics of Meckel＇s diverticulum in children.Methods Ret-rospective analysis was adopted to analyze the clinical and pathologic data of 135 children with Meckel＇s diverticulum that were from January 2011 to September 2013.Results Digestive symptoms of 135 cases included 92 cases with vomiting（68.1%）,63 case with bloody tool（46.7%）,59 cases with abdominal pain（43.7%）.Among 49 cases,20 cases with anal diagnosis induced jam stool sam-ple,5 cases with red blood stool,1 1 cases with yellow stool and gas,and the remaining 1 3 cases without stool.Clinical complications divided into 86 patients with intestinal obstruction（63.7%）,62 patients with gastrointestinal bleeding（45.9%）,49 patients with a-cute diverticulitis（36.3%）,39 patients with acute intussusception（28.9%）,25 patients with intestinal necrosis（18.5%）,16 pa-tients with acute diffuse peritonitis（11.9%）,15 patients with acute appendicitis（11.1%）.35 cases who had positive finding of ^99m TcO4-ectopic gastric mucous membrane imaging occurred Meckel′s diverticulum during operation.Histopathologic examination was carried out in 135 cases with Meckel＇s diverticulum during operation,all cases were confirmed as Meckel＇s diverticulum and with ectopic mucosal epithelium,accompanied by diverticulum infection and hemorrhage and necrosis,ulceration,chronic appendici-tis,intestinal bleeding necrosis,focal peritonitis,small patches of pancreatic tissue.Conclusion Meckel＇s diverticulum most oc-curred with vomiting,bloody stools and abdominal pain as the main clinical symptoms.Symptoms of meckel＇s diverticulum often oc-cur along with the occurrence of complications,^99m TcO4-gastrointestinal imaging is helpful to diagnosis of meckel＇s diverticulum diseases.