儿童美克尔憩室临床诊治分析

Clinical diagnosis and treatment of Meckel＇s diverticulum in children

目的探讨儿童美克尔憩室的临床特点、病理特征及诊治要点。方法回顾性分析2010年1月至2014年12月在浙江大学医学院附属儿童医院手术的244例儿童美克尔憩室病例的临床资料。结果本组244例病例中，50例为其他手术中探查意外发现，其余194例中以消化道出血为临床表现者76例，伴发感染穿孔48例，肠梗阻36例，诱发肠套叠31例，另有2例Littre疝，1例憩室异物嵌顿。憩室严重并发症34例，包括肠扭转坏死9例，伴穿孔及腹膜炎16例，重度贫血9例。76例消化道出血病例中，行^99mTc异位胃黏膜扫描61例，其中阳性42例，19例扫描结果阴性患儿行胶囊内镜检查8例，3例报告小肠憩室的可能。242例行一期手术切除。术后病理报告128例存在异位胃黏膜或异位胰腺组织。本组因肠扭转、肠坏死死亡1例，吻合口瘘1例给予再次手术修补。术后随访1-5年，并发黏连性肠梗阻和切口感染各2例。结论对于有腹膜炎、肠梗阻及消化道出血表现的患儿，要高度怀疑美克尔憩室的可能；异位黏膜组织是导致美克尔憩室并发症的主要原因。

Objective To evaluate the clinical characteristics and pathological features of Meckel＇s diverticulum（MD） in children. Methods 244 MD cases admitted between January 2010 and December 2014 were retropectively analyzed. Results In fifty patients, MD was an incidental finding at laparotomy or laparoscopy for unrelated entities. Among the remaining 194 symptomatic patients, there were 76 patients presenting GI bleeding, forty eight patients were identified with perforated Meckel＇s diverticulum, thirty six patients suffered from intestinal obstruction. 34 patients had MD caused severe complications such as volvulus and intestinal necrosis, diverticular perforation and peritonitis. 61 out of 76 GI bleeding patients underwent a 99roTe scan, and positive tracer was found in 42 patients. Among the 19 negative 99mTc scan patients, 8 received capsule endoscopy and only 3 patients were suspected of diverticulum. 242 patients underwent one stage resection of the diverticulum. Histology revealed ectopic gastric mucosa or ectopic pancreatic tissue in 128 patients. One patient died of volvulus and intestinal necrosis postoperatively, and two suffered from adhesive intestinal obstruction during one to five year＇s follow up. Conclusions It is necessary to maintain a high suspicion of MD in the pediatric age group with symptoms of abdominal pain, gastrointestinal hemorrhage or intestinal obstruction. Ectopic mucosa assumes the ultimate responsibility for major complications of MD.