经脐单部位腹腔镜对儿童梅克尔憩室诊断与治疗的临床分析

Clinical Analysis of the Diagnosis and Treatment of Children's Merkel's Diverticulum by Laparoscopic Single Site Laparoscopy

目的:探讨儿童梅克尔憩室(MD)诊断及治疗中经脐单部位腹腔镜的应用范围。方法:回顾性的分析我们医院自2013年5月至2018年5月收治的29例儿童梅克尔憩室行经脐单部位腹腔镜下梅克尔憩室切除术的病例资料。29例患儿中19例以间歇性便血病史为主诉入院(A组),10例以腹痛为主要症状入院(B组),19例间隙性血便史患儿术前完善电子胃镜及纤维结肠镜检查,尚不能确定造成血便病史的原因,术前完善同位素消化道扫描,11例患儿在下腹部高度提示同位素物聚集,8例患儿同位素扫描未显示消化道同位素聚集。10例以腹痛为主诉入院的患儿,术前B超均未提示梅克尔憩室。29例患儿均顺利完成经脐单部位腹腔镜梅克尔憩室切除术。结果:所有患儿术后恢复较佳,随访3个月,A组患者未再出现便血,B组患儿均未出现腹痛。结论:在儿童梅克尔憩室诊断与治疗中经脐单部位腹腔镜具有无瘢痕、创伤小等优点,有一定的临床推广价值。

Objective:To explore the application of transumbilical laparoscopy in the diagnosis and treatment of Meckel’s diverticulum(MD)in children.Methods:The data of 29 cases of Meckel’s diverticulum in children who underwent transumbilical laparoscopic Meckel's diverticulectomy in our hospital from May 2013 to May 2018 were analyzed retrospectively.Of 29 cases,19 cases complained of intermittent hematochezia(group A),10 cases were admitted with abdominal pain(group B).Preoperative electronic gastroscopy and fiberoptic colonoscopy were perfected in 19 children with intermittent hematochezia history,but the cause of hematochezia history could not be determined.Preoperative isotope digestive tract scanning was perfected.Eleven children showed high concentration of isotopes in the lower abdomen,and eight children showed no accumulation of isotopes in the digestive tract.Ten children who complained of abdominal pain were admitted to hospital.No Meckel's diverticulum was detected by B-mode ultrasound before operation.Result:All the children recovered well after operation.Follow-up for 3 months showed that there was no hematochezia in group A and no abdominal pain in group B.Conclusion:In the diagnosis and treatment of Meckel's diverticulum in children,transumbilical single-site laparoscopy has the advantages of scarless,less trauma,and has a certain clinical value.