6例小儿肠道多发憩室、肠重复畸形的诊治分析

Diagnosis and treatment of multiple ileal diverticulum and intestinal duplication in children:a report of 6 cases.

目的探讨小儿肠道多发憩室、肠重复畸形的临床特点、诊断及治疗方法。方法收集湖南省儿童医院2010年1月1日至2018年12月30日收治的梅克尔憩室、肠重复畸形患者546例作为研究对象,其中6例为肠道多发憩室、憩室合并肠重复畸形,对该6例患者的临床资料、辅助检查、治疗经过进行回顾性分析。结果6例患者以消化道出血、肠梗阻、腹腔感染等为主要临床表现,其中继发性肠套叠1例、肠梗阻2例、消化道出血2例、腹腔感染1例。手术方式采用腹腔镜探查病变肠段切除肠吻合术和剖腹探查术,其中开腹手术3例,腹腔镜手术3例;1例病例二次手术因继发性肠套叠行腹腔镜探查、梅克尔憩室切除术,术后6个月再次出现继发性肠套叠,行第二次腹腔镜探查、回盲部肠源性囊肿切除肠吻合术;本组6例均行病变肠管切除,其中两处肠吻合4例,一处肠吻合2例。所有患者术后恢复良好,未出现吻合口瘘等并发症。结论小儿肠道憩室及肠重复畸形在小儿肠道畸形中以单发多见,多发病变易漏诊。两者临床表现类似,多发病变术前无有效的诊断方法,术中仔细探查是诊断多发病变及减少漏诊的关键。分段切除病变肠管,多处肠切除吻合是安全可行的治疗方法。

Objective To explore the clinical features,diagnosis and treatment of multiple ileal diverticulum and intestinal duplication in children.Methods A total of 546 children with Meckel s diverticulum or intestinal duplication were treated.There were 6 cases of multiple ileal diverticulums or diverticulum associated intestinal duplication.Their clinical data were collected and analyzed retrospectively.Results The clinical manifestations were gastrointestinal hemorrhage,intestinal obstruction and abdominal infection.There were recurrent intussusception(n=1),intestinal obstruction(n=2),gastrointestinal hemorrhage(n=2)and abdominal infection(n=1).Laparoscopic exploration or laparotomy was performed,including laparotomy(n=3)and laparoscopy(n=3).Secondary surgery was performed(n=1).And secondary intussusception recurred at Month 6 after laparoscopic exploration.Diverticulum resection and laparoscopic re-exploration was performed.Two-site intestinal anastomosis(n=4)and one-site intestinal anastomosis(n=2)were performed.All cases recovered well postoperatively without anastomotic leakage.Conclusion Single intestinal diverticulum and intestinal duplication are common in children while multiple type is rare.Multiple lesions are prone to missing.The symptoms and signs are similar between single and multiple types.Meticulous intraoperative exploration is a diagnostic key of multiple lesions.Multiple bowel resection and anastomosis are both safe and feasible.