腹腔镜下结合术中冰冻基底部结扎法切除儿童美克尔憩室43例

Combined with intraoperative frozen section laparoscopic-assisted resection of Meckel's diverticulum-43 cases report

目的探讨在腹腔镜辅助下,结合术中冰冻,基底部结扎法切除儿童美克尔憩室的临床效果及优势。方法对43例美克尔憩室患儿采取单纯基底部结扎法切除美克尔憩室,行术中冰冻病理检查,判断基底部是否残留异位粘膜组织,再决定是否结束手术或行锲行肠切除或肠切除术。结果 43例患儿均顺利完成手术,4例因基底部残留异位粘膜组织,遂行锲行切除或肠切除术,其余所有病例术中冰冻均未见残留异位粘膜,于基底部结扎后结束手术。术后随访6个月至7年,所有患儿均未见再次便血、肠瘘等并发症。结论采用术中冰冻病理检查,可以很好的判断基底部是否残留美克尔憩室异位粘膜,而行基底部结扎是安全有效的全新手术方式,可以明显缩短手术时间,缩短术后禁食的时间。

Objective To investigate the clinical effects and advantages of a new operation for Meckel＇s diverticulum：basal ligation combined with intraoperative frozen section using laparoscopy. Methods 43 cases of Meckel＇s diverticulum were resected with simple basal ligation operation using laparoscopy. Intraoperative frozen pathological section were performed to determine surgery strategies. Based on the existence of basal residual ectopic mucosa,surgery was termination or underwent wedge intestinal resection or bowel resection. Results All 43 surgeries were successfully completed. Only 4 of them were performed with wedge resection or bowel resection due to the presence of ectopic basal residual gastric mucosa. In the rest of the cases,no ectopic mucosa was found,and the operation was ended after basal ligation. All patients had no complications recurred such as intestinal fistula,bleeding in 6 months to 7 years after surgery. Conclusion Intraoperative frozen pathological examination can well determine whether there is ectopic Meckel＇s diverticulum mucosa in the basal part. Basal ligation is an safe and effective operation method,and it can significantly shorten the operation time and postoperative fasting time.