小儿美克尔憩室并发消化道出血的诊治  

The diagnosis and treatment of pediatric Meckel diverticulum complicated with gastrointestinal bleeding

作　　者：孙为增[1] 覃伶伶[1] 林国雄[1] 林海[1] 

机构地区：[1]海南省人民医院,海南海口570311

出　　处：《腹腔镜外科杂志》2016年第7期529-532,共4页Journal of Laparoscopic Surgery

摘　　要：目的：探讨小儿美克尔憩室（Meckel diverticulum,MD）合并出血的超声影像特点及手术要点。方法：回顾分析2013-2015年因消化道出血住院,经超声检查确诊为MD的14例患儿的临床资料。结果：术前14例经超声诊断MD,手术病理均与超声诊断一致,诊断符合率100%,其中12例憩室含胃黏膜上皮,2例为胰腺黏膜上皮。患儿均行经脐单孔法腹腔镜辅助手术,将憩室自脐部提出并切除。其中肠切除肠吻合6例,楔形切除8例。无中转开腹及切口感染、吻合口漏等并发症发生,无便血复发。结论：超声检查可作为可疑MD并出血的首选诊断方法。对于高度怀疑MD并出血的患儿,应常规行超声检查,操作简便,诊断准确率高。一经确诊,均应急诊手术,经脐单孔腹腔镜辅助切除美克尔憩室操作简单,切口美观,术后康复快,并发症少,疗效满意。Objective：To analyze sonographic patterns and main treatment points of pediatric Meckel diverticulum （MD） complicated with gastrointestinal bleeding. Methods： Fourteen children with gastrointestinal bleeding were treated from 2013 to 2015, they were diagnosed with MD by uhrasonography. The sonographic patterns and main treatment points were retrospectively analyzed. Results： Fourteen cases of MD were diagnosed by ultrasound before operation, all of them were confirmed by pathology. The correct rate of ultrasound was 100%. Among them, 12 cases had gastric mucosal epithelium,2 cases had mucosal epithelium of pancreas. All children un- derwent transumbilical single-port laparoscopic-assisted operation,the diverticulum was pulled out through the umbilicus and excised. Intestinal anastomosis was applied in 6 cases ,8 patients received wedge excision. There were no conversion to laparotomy or complications such as incision infection, anastomotic leak or recurrence of bleeding. Conclusions：The uhrasonography can be the first choice to diagnose MD with bleeding. Patients highly suspected with MD and hemorrhage should routinely undergo ultrasound,which is easy and of high diagnosis rate. As soon as diagnosis of MD, emergent surgery should be performed. Transumbilical single-port laparoscopic-assisted excision of MD in children is simple with cosmetic incision, quick recovery ,few complications and satisfactory therapeutic effect.

关 键 词：美克尔憩室 胃肠出血 超声检查 腹腔镜检查 

分 类 号：R726.5[医药卫生—儿科]