儿童内翻型梅克尔憩室继发肠套叠临床特点及诊治

Clinical features,diagnosis and treatment of intussusception secondary to inverted Meckel′s diverticulum in children

目的探讨儿童内翻型梅克尔憩室的临床特点、诊治及预后情况, 总结临床经验。方法回顾性分析2018年10月至2021年10月收治于首都医科大学附属北京儿童医院, 行手术治疗, 诊断为梅克尔憩室, 资料完整且可获得随访信息的10例患儿临床资料。总结归纳其临床特点、诊治及预后情况。患儿男6例, 女4例;发病年龄5个月~12岁5个月。临床表现为腹痛8例, 哭闹2例, 伴血便3例。B超均提示怀疑继发因素, 其中小肠套叠6例, 回结型套叠4例, 其中1例小肠套叠为外院腹腔镜探查术后漏诊, 反复肠套叠。10例患儿均行节段性肠切除。结果 10例患儿中, 8例行腹腔镜探查, 2例继发肠坏死行开腹手术, 术后病理均提示梅克尔憩室, 8例可及异位组织, 其中7例胃腺异位, 1例胰腺异位。术后随访期间(1个月~3年), 患儿一般情况良好, 无肠梗阻等并发症。结论内翻型梅克尔憩室继发肠套叠少见, 术前难以诊断, 明确诊断靠手术探查及术后病理。内翻型梅克尔憩室即使手术探查术中也易漏诊, 因此需仔细探查。

Objective To explore the clinical characteristics,diagnosis,treatment and prognosis of inverted Meckel′s diverticulum in children,and to summarize the clinical experience.Methods Ten children who received surgical treatment in Beijing Children′s Hospital,Capital Medical University from October 2018 to October 2021 were retrospectively analyzed.The children were diagnosed with Mecker′s diverticulum.Their data were complete and their fo-llow-up information was available.The clinical features,diagnosis,treatment and prognosis were summarized.There were 6 males and 4 females,whose age of onset ranged from 5 months to 12 years and 5 months.The clinical manifestations were abdominal pain in 8 cases,crying in 2 cases and bloody stool in 3 cases.B-ultrasound showed suspected diseases secondary to inverted Meckel′s diverticulum,including small intestinal intussusception in 6 cases and back junction type intussusception in 4 cases.One case of small intestinal intussusception was misdiagnosed after laparoscopic exploration in other hospitals and suffered from recurrent intussusception.All patients underwent segmental bowel resection.Results Of the 10 children,8 cases received laparoscopic exploration and 2 cases underwent open surgery for secondary intestinal necrosis.Postoperative pathology revealed Meckel′s diverticulum.Ectopic tissue was accessible in 8 cases,including ectopic gastric tissue in 7 cases,and ectopic pancreas in 1 case.During the postoperative follow-up period(1 month-3 years),the patients were generally in good condition with no complications such as intestinal obstruction.Conclusions Intussusception secondary to inverted Meckel′s diverticulum is rare and difficult to diagnose before operation.The diagnosis should be confirmed by surgical exploration and postoperative pathology.However,careful surgical exploration is required since inverted Meckel′s diverticulum is prone to be misdiagnosed during exploration.