| 摘要: |
| 目的 探讨小儿梅克尔憩室引起的肠梗阻的临床特点，提高对该疾病的认识和诊治水平。方法 回顾性分析华中科技大学同济医学院附属武汉儿童医院普外科2015年7月至2022年6月收治的103例梅克尔憩室并发肠梗阻患儿的临床资料。男78例、女25例，年龄为4个月至12岁，平均年龄为（4.7±2.6）岁。103例患儿均以不明原因的腹痛、哭吵、呕吐或腹胀等就诊。结果 74例患儿行剖腹探查术，29例行腹腔镜探查。术中发现梅克尔憩室并索带形成压迫肠管致肠梗阻65例，憩室穿孔粘连梗阻15例，继发性肠套叠导致梗阻23例。23例继发性肠套叠行肠套叠手法整复＋梅克尔憩室切除术。39例合并肠坏死，其中38例行索带松解＋坏死肠管切除＋肠吻合术，1例因合并感染性休克行坏死肠管切除＋肠造瘘术。其余患儿12例行索带松解＋憩室切除术，14例行腹腔镜下索带松＋解憩室切除术，15例行腹腔镜中转开腹憩室切除术。所有患儿均临床治愈，随访1年以上，无吻合口瘘、伤口感染等并发症发生。结论 合并索带形成是梅克尔憩室引起肠梗阻的主要原因，早期症状不典型，缺乏特异性症状体征和检查手段，漏诊误诊率高，容易引起肠坏死、感染性休克等严重并发症。对不明原因肠梗阻，应警惕梅克尔憩室引起肠梗阻的可能。 |
| 关键词: 儿童 梅克尔憩室 肠梗阻 继发性肠套叠 |
| DOI：10.16781/j.CN31-2187/R.20230573 |
| 投稿时间：2023-10-19修订日期：2024-01-05 |
| 基金项目: |
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| Diagnosis and treatment of Meckel diverticulum complicated with intestinal obstruction in children: an analysis of 103 cases in a single center |
| ZHU Zhenchuang,YAN Xueqiang*,KUANG Houfang,DUAN Xufei,PENG Fei,QIN Xinke |
(Department of General Surgery, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, Hubei, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the clinical characteristics of intestinal obstruction caused by Meckel diverticulum in children, so as to improve the understanding, diagnosis and treatment of this disease. Methods The clinical data of 103 children with intestinal obstruction caused by Meckel diverticulum admitted to Department of General Surgery, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology from Jul. 2015 to Jun. 2022 were retrospectively analyzed. There were 78 males and 25 females, with an average age of (4.7±2.6) years old (ranged from 4 months to 12 years old). All 103 cases were admitted for abdominal pain, crying, vomiting or abdominal distension with unknown causes. Results Seventy-four children underwent exploratory laparotomy and 29 underwent laparoscopic exploration. During the operation, it was found that Meckel diverticulum combined with the formation of cord oppressed the intestinal tract, resulting in intestinal obstruction in 65 cases; diverticulum perforation and adhesion obstruction in 15 cases; and secondary intussusception leading to obstruction in 23 cases. Twenty-three cases of secondary intussusception underwent manual reduction of intussusception and Meckel diverticulectomy. Thirty-nine cases were complicated with intestinal necrosis, of which 38 cases underwent cord release, necrotic bowel resection, and intestinal anastomosis; 1 case underwent necrotic bowel resection and intestinal fistula due to septic shock. Twelve cases underwent cord release and diverticulectomy, 14 cases underwent laparoscopic cord release and diverticulectomy, and 15 cases underwent laparoscopic surgery conversion to diverticulectomy. All patients were clinically cured and followed up for more than 1 year, and no anastomotic leakage, wound infection or other complications occurred. Conclusion The formation of cord is the main cause of intestinal obstruction caused by Meckel diverticulum, with atypical early symptoms, lack of specific symptoms, signs and examination methods, leading to a high misdiagnosis rate. It often causes serious complications such as intestinal necrosis and septic shock. For cases of intestinal obstruction with unknown causes, we should be alert to the possibility of intestinal obstruction caused by Meckel diverticulum. |
| Key words: children Meckel diverticulum intestinal obstruction secondary intussusception |
