单气囊小肠镜对成人Meckel憩室的诊断价值

Single-balloon Enteroscopy for Diagnosis of Meckel Diverticulum in Adults

背景:Meckel憩室是常见的先天性消化道畸形,成人相对罕见,术前诊断困难。目的:分析成人Meckel憩室的临床特点,评价单气囊小肠镜对成人Meckel憩室的诊断价值。方法:纳入2011年4月—2019年1月于上海交通大学医学院附属仁济医院经单气囊小肠镜检查确诊Meckel憩室的成人患者进行回顾性分析。结果:共30例患者纳入研究,其中男性26例,女性4例,平均年龄(36.1±14.6)岁,病程6 d^30年。消化道出血发生率为73.3%(22/30),腹痛、腹泻发生率为40.0%(12/30),贫血发生率为50.0%(15/30)。所有憩室均于经肛途径检查中被发现,憩室距回盲瓣(98.7±29.5)cm,憩室开口大小平均3.25 cm。11例患者合并溃疡。16例患者接受外科手术治疗,术后病理证实分别有12.5%和18.8%的病灶内含有异位胃黏膜和异位胰腺。胶囊内镜和影像学检查诊断阳性率均较低,分别为39.1%和20.7%。结论:单气囊小肠镜对成人Meckel憩室具有较高的诊断价值,并可为临床治疗提供指导。临床上对于疑似Meckel憩室的成人患者,推荐首选经肛途径单气囊小肠镜检查。

Background:Meckel diverticulum is one of the most common congenital malformations of the gastrointestinal tract.It is relatively rare in adults and is difficult to make a preoperative diagnosis.Aims:To analyze the clinical characteristics of Meckel diverticulum in adults and to investigate the diagnostic value of single-balloon enteroscopy for adult Meckel diverticulum.Methods:A retrospective study was performed in patients diagnosed as adult Meckel diverticulum by single-balloon enteroscopy at Renji Hospital,School of Medicine,Shanghai Jiao Tong University from Apr.2011 to Jan.2019.Results:A total of 30 adult Meckel diverticulum patients were enrolled.Of them,26 were male and 4 were female with a mean age of(36.1±14.6)years.The mean duration of symptoms ranged from 6 days to 30 years.The prevalence of gastrointestinal bleeding,abdominal pain/diarrhea,and anemia was 73.3%(22/30),40.0%(12/30),and 50.0%(15/30),respectively.All the diverticula were detected by retrograde single-balloon enteroscopy.The mean distance of diverticulum from the ileocecal valve was(98.7±29.5)cm,and the size of diverticulum opening was 3.25 cm on average.Ulcer was found in 11 cases.Sixteen cases underwent surgical resection,and 12.5%and 18.8%of them were proved to contain ectopic gastric mucosa and ectopic pancreas,respectively.The diagnostic yield of capsule endoscopy and imaging modalities were relatively low(39.1%and 20.7%,respectively).Conclusions:Single-balloon enteroscopy has a high diagnostic value for Meckel diverticulum in adults and may provide guidance for clinical treatment.For adults suspected of Meckel diverticulum,retrograde single-balloon enteroscopy is recommended.