157例有症状麦克尔憩室的术前诊断方法分析  

The preoperative diagnosis methods analysis of 157 cases with symptomatic Meckel′s diverticulum

作　　者：黄小珊 吴封菲 王威东 石洁 谢芳[1] 白岚[1] HUANG Xiao-shan;WU Feng-fei;WANG Wei-dong;SHI Jie;XIE Fang;BAI Lan(Department of Gastroenterology,Nanfang Hospital,Southern Medical University,Guangzhou,Guangdong 510515,China;Guangdong Provincial Key Laboratory of Gastroenterology)

机构地区：[1]南方医科大学南方医院消化科,广东省胃肠病学重点实验室,510515

出　　处：《现代消化及介入诊疗》2021年第5期565-570,共6页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：国家自然科学基金(81970451、82070534);广东省科技计划项目(2017B020209003);广东省自然基金(2019A1515010667、2020A1515010999);广东省教育厅高水平大学建设经费南方医科大学临床研究启动项目(LC2019ZD021);南方医科大学南方医院“临床研究专项”(2020CR027、2018CR038)。

摘　　要：目的探讨不同检查方法对有症状麦克尔憩室的术前诊断价值。方法回顾性分析2000年1月至2018年8月于我院经手术确诊的157例麦克尔憩室患者的临床资料,包括一般资料、临床表现、诊断方法、术中发现和病理等。按临床症状(非出血组和出血组)及发病年龄(成人组和儿童组)分组比较各检查方法对麦克尔憩室的诊断率。结果不同检查对有症状麦克尔憩室的诊断率分别为:双气囊小肠镜(DBE)76.04%(73/96),胶囊内镜(CE)20.29%(14/69),异位胃黏膜显像68.18%(30/44),99锝m-红细胞(^(99)Tc^(m)-RBC)体内标记核素显像33.33%(6/18),计算机断层扫描(CT)平扫3.03%(1/33),CT增强6.06%(2/33),CT小肠造影(CTE)33.33%(1/3),CT血管造影(CTA)16.67%(1/6)、数字减影血管造影(DSA)15.38%(4/26)。所有患者中,异位胃黏膜显像阳性率高于CT平扫、CT增强、CE(χ^(2)=33.28,29.96,25.92;P<0.05)。异位胃黏膜显像对成人组及儿童组诊断率差异无统计学意义(χ^(2)=0.056,P>0.05)。DBE诊断率高于CE(χ^(2)=50.06;P<0.05)。出血组患者中,异位胃黏膜显像诊断率高于^(99)Tc^(m)-RBC显像、DSA(χ^(2)=6.371,18.237;P<0.05)。结论对麦克尔憩室诊断率高的检查依次为DBE、异位胃黏膜显像、CE。异位胃黏膜显像可作为综合性医院中对于疑诊麦克尔憩室患者的首选检查方法。Objective To investigate preoperative diagnostic values of different methods of symptomatic Meckel′s diverticulum(MD).Methods Clinical data of 157 patients found to have MD during surgery from January 2000 to August 2018 were retrospectively reviewed,including general information,clinical manifestation,results of different examinations,intraoperative macroscopic findings,and pathology reports.The diagnostic rate of each examination method for Meckel′s diverticulum was then compared according to the clinical symptoms(non-bleeding group and bleeding group)and age of onset(adults and children).Results The diagnostic rates of double-balloon enteroscopy(DBE),capsule endoscopy(CE),Meckel′s Tc-99m pertechnetate scan,99m Tc-RBC scintigraphy,non-enhanced CT,contrast enhanced CT,computed tomography enterography(CTE),computed tomography angiography(CTA)and digital subtraction angiography(DSA)were 76.04%(73/96),20.29%(14/69),68.18%(30/44),33.33%(6/18),3.03%(1/33),6.06%(2/33),33.33%(1/3),16.67%(1/6)and 15.38%(4/26),respectively.In all patients,the positive rate of ectopic gastric mucosa imaging of Meckel′s scan was higher than non-enhanced CT,contrast enhanced CT and CE(χ^(2)=33.28,29.96,25.92;P<0.05).There was no statistically significant difference in the diagnostic rate of Meckel′s scan between the adult and child group(χ^(2)=0.056,P>0.05).The diagnostic rate of DBE was higher than CE(χ^(2)=50.06;P<0.05).Among the bleeding group,the diagnostic rate of Meckel′s scan was higher than 99m Tc-RBC scintigraphy and DSA(χ^(2)=6.371,18.237;P<0.05).Conclusion The high diagnostic rate of Meckel′s diverticulum was DBE,ectopic gastric mucosa imaging and CE.Ectopic gastric mucosa imaging can be used as the preferred examination method for patients with suspected Meckel′s diverticulum in general hospitals.

关 键 词：麦克尔憩室 小肠镜 异位胃黏膜显像 诊断 

分 类 号：R574[医药卫生—消化系统]