成人Meckel憩室40例临床特征与诊断方法分析  

Clinical features and diagnostic modalities of adult Meckel′s diverticulum

作　　者：周艳华[1] 王继龙 刘揆亮 宗晔[1] Zhou Yanhua;Wang Jilong;Liu Kuiliang;Zong Ye(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Disease,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院消化内科、国家消化系统疾病临床医学研究中心,北京100050

出　　处：《中华全科医师杂志》2024年第4期379-383,共5页Chinese Journal of General Practitioners

摘　　要：目的分析成人Meckel憩室的临床特征,并探讨不同影像学和内镜检查方法对成人Meckel憩室术前诊断的价值。方法该研究为回顾性研究。回顾分析2013年1月至2023年10月于首都医科大学附属北京友谊医院确诊的成人Meckel憩室患者的临床表现、诊断方法、治疗情况和病理结果。结果共40例患者,男性32例(80.0%),女性8例(20.0%),男女比例为4∶1,中位年龄39岁。因消化道出血、腹痛就诊者和无症状者分别占52.5%(21/40)、12.5%(5/40)和35.0%(14/40)。其中因消化道出血就诊者病程0~13年,最低血红蛋白水平为(67±14)g/L,47.6%(10/21)的患者曾输注同型悬浮红细胞治疗。腹部CT、血管造影、核素异位胃黏膜显像和核素锝标记红细胞出血显像等检查的术前诊断阳性率分别为2.6%(1/39)、0(0/7)、3/7和2/4;胶囊内镜和经肛单气囊小肠镜的诊断率分别为1/12和85.0%(17/20)。34例患者经外科手术成功治疗,术中显示憩室距回盲瓣距离20~170 cm;术后病理活组织检查结果均符合小肠憩室改变,其中7例(23.5%)病理结果显示存在异位胃黏膜,2例(5.9%)显示存在异位胰腺组织。结论成人Meckel憩室男性患者居多,多以消化道出血首发,经肛小肠镜检查诊断阳性率最高,手术是推荐治疗方法。Objective To analyze the clinical features and diagnostic modalities of adult Meckel′s diverticulum.Methods The clinical manifestations,diagnostic modalities,treatments and pathology of 40 adult patients with Meckel′s diverticulum admitted in Beijing Friendship Hospital,Capital Medical University from January 2013 to October 2023 were retrospectively analyzed.Results There were 32 male cases(80.0%)and 8 female cases(20.0%)with male to female ratio of 4∶1 and a median age of 39 years.Patients with gastrointestinal bleeding,abdominal pain and asymptomatic patients accounted for 52.5%(21/40),12.5%(5/40)and 35.0%(14/40),respectively.The average minimum hemoglobin was(67±14)g/L and 47.6%patients(10/21)received blood transfusion.The preoperative diagnostic rates of CT scan,angiography,Tc-99m pertechnetate scintigraphy and tagged red blood cell(TRBC)scan were 1/39,0/7,3/7 and 2/4,respectively.The diagnostic rates of capsule endoscopy and retrograde single balloon enteroscopy were 1/12 and 17/20(85.0%).The distance between Meckel′s diverticulum and ileocecal valve was 20-170 cm.Histopathological examination revealed ectopic gastric mucosa and ectopic pancreatic tissue in 23.5%(7/34)and 5.9%(2/34)patients.Conclusions Adult Meckel′s diverticulum is more common in male patients,often presenting with gastrointestinal bleeding as the initial symptom.Diagnosis is most commonly made through retrograde single balloon enteroscopy,and surgery is the recommended treatment method.

关 键 词：美克尔憩室 99m锝高锝酸钠 胃黏膜 单气囊小肠镜检查 

分 类 号：R574[医药卫生—消化系统]