72例Meckel憩室并出血回顾性分析

Meckel’s diverticulum with hemorrhage:a retrospective analysis of 72 cases

目的探讨Meckel憩室(Meckel’s diverticulum,MD)并出血的临床特征、病理及预后相关分析。方法回顾性分析陆军军医大学第二附属医院2009年11月至2020年11月期间经肛单气囊小肠镜(single balloon enteroscopy,SBE)诊断72例MD并出血患者的临床资料、内镜特点及术后病理类型。结果①72例患者临床均表现为反复便血,病程最短4 d,最长27年;其中男性59例(82%,59/72),女性13例(18%,13/72);年龄13~59(27.92±11.15)岁;血红蛋白浓度29~162(93.86±27.66)g/L;憩室距回盲瓣距离32~150(90.90±30.79)cm;②56例患者(77.8%,56/72)接受了外科手术治疗,15例患者(21%,15/72)接受了内科保守治疗,1例患者(0.1%,1/72)接受了介入治疗;外科组手术方式为:憩室整体连同局部肠管切除15例(26.8%,15/56),憩室局部楔形切除41例(73.2%,41/56);③外科术后再出血占16.1%(9/56),内科保守治疗后再出血占33.3%(5/15),单因素分析显示外科术后再出血危险因素与手术方式不相关;④外科术后病理提示:憩室伴慢性炎症38例(67.8%,38/56)、憩室伴异位胃黏膜14例(25%,14/56)、憩室伴异位胰腺2例(3.6%,2/56)及憩室伴血管畸形2例(3.6%,2/56)。结论Meckel憩室诊断较困难;Meckel憩室外科手术术后再出血率明显低于内科保守治疗,外科术后再出血风险与手术方式无关;Meckel憩室术后病理学以慢性炎症和组织异位为主。

ObjectiveTo explore the clinical features,pathology and prognosis of Meckel’s diverticulum(MD)with bleeding.MethodsClinical data,endoscopic characteristics and postoperative pathological types of 72 patients who were diagnosed with single balloon enteroscopy(SBE)in the Second Affiliated Hospital of Army Medical University from November 2009 to 2020 were collected and analyzed.Results①The 72 patients manifested as recurrent hematochezia,with a course lasting from 4 d to 27 years.They were 59 males(82%,59/72)and 13 females(18%,13/72),at an age from 13 to 59(27.9±11.15)years.The hemoglobin level ranged from 29 to 162(93.86±27.66)g/L.Anal SBE showed the diverticulum was 32 to 150(90.90±30.79)cm from the ileocecal valve;②Among them,56 patients(77.8%,56/72)underwent surgical treatment,15 patients(21%,15/72)received conservative medical treatment,and 1 patient(0.1%,1/72)took interventional treatment.The operation procedures included resection of the diverticulum and partial bowel in 15 patients(26.8%,15/56)and wedge resection of the diverticulum in 41 cases(73.2%,41/56);③Rebleeding was observed in 9 cases after surgical operation(16.1%,9/56)and in 5 cases after conservative treatment(33.3%,5/15).Univariate analysis showed that the risk factors of rebleeding after surgical treatment were not related with surgical procedures;④Postoperative pathology indicated that diverticula with chronic inflammation accounted for 67.8%(38/56),diverticulum with ectopic gastric mucosa for 25.0%(14/56),diverticulum with ectopic pancreas for 3.6%(2/56)and diverticulum with vascular malformation for 3.6%(2/56).ConclusionMD is hard to diagnose.Surgical treatment obtains significantly lower rebleeding rate than conservative treatment,and the risk of postsurgical rebleeding is not related to the surgical procedures.Pathological study shows that MD is mainly chronic inflammation and heterotopic tissue.