儿童梅克尔憩室的诊断及并发症的临床分析

重庆医科大学附属儿童医院胃肠新生儿外科,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,重庆市儿童发育重大疾病诊治与预防国际科技合作基地(重庆市,400014 )通信作者:王佚,E-mail: wy757311@ hotmail.com

梅克尔憩室; 诊断; 并发症; 儿童

Diagnosis and complications of Meckel's diverticulum in children.
Chen Xiulan, Wu Yonglong, Li Xiaoqing, Liu Wei, Wang Yi.

Department of Pediatric Surgery, Ministry of Education Key Laboratory of Child Development & Disorder, Chongqing Key Laboratory of Pediatrics, China International Science & Technology Cooperation Base of Child development & Critical Disorders, Children's Hospital, Chongqing Medical University, Chongqing 400014, China,Corresponding author: Wang Yi, E-mail: wy757311@hotmail.com

Meckel's diverticulum; Diagnosis; Complications; Child

DOI: 10.3969/j.issn.1671-6353.2017.01.014

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目的 总结儿童梅克尔憩室(MD)的临床诊断及并发症的诊治要点,为临床合理治疗提供参考。 方法 回顾性分析98例儿童梅克尔憩室的临床特点及辅助检查结果,总结其对于准确诊断梅克尔憩室的价值及并发症的诊治情况。 结果 ①98例梅克尔憩室患儿,男性76例,女性22例,男女比例约为3.5:1,并发症包括梅克尔憩室引起的便血、肠梗阻、炎症等,以便血最常见(58/98,59.18%)。②51例患儿术前行99TcmO-4检查,其中43例提示为异位胃黏膜,检出率为84.31%; 84例术前行腹部超声检查,其中37例考虑梅克尔憩室,检出率为44.05%,经卡方检验,放射性核素与超声对MD患者检查结果有统计学差异( χ2= 5.852,P=0.02)。③58例以便血为主要表现的患儿中,42例术前共同行了放射性核素检查和超声检查,阳性发现率分别为80.95%和66.67%。经卡方检验,放射性核素与超声对MD伴便血患儿检查结果无统计学差异( χ2=2.217,P=0.14)。 结论 MD临床表现缺乏特异性,以并发便血最多,超声在诊断MD伴便血中有较高的特异性,联合放射性核素检查可提高检出率; 对于MD伴炎症及肠梗阻的患儿,急诊超声对其各种并发症的检出及判断具有较高的诊断符合率,有利于减少急腹症的误诊。
Objective To explore the diagnosis and complications of Meckel's diverticulum(MD)in children and provide rationales for optimized surgical approaches. Methods Retrospective analyses were conducted for 98 MD children with regards to clinical symptoms and laboratory findings. And their clinical characteristics and diagnostic modalities were summarized. Results Among them, there were 77 boys and 22 girls with a gender ratio of approximately 3.5:1. The clinical complications included hemorrhage, intestinal obstruction, diverticulitis. And hemorrhage was one of the most common complications(58/98=59.18%). Fifty-one cases received 99TcmO4-examination. And 43 cases had ectopic gastric mucosa with a detection rate of 84.31%. Among 84 cases with preoperative ultrasonography, 37 had MD with a detection rate of 44%. Significant difference existed between radionuclide and ultrasonography in detecting MD(P<0.05). For 58 children with bloody stool, 42 cases were examined by both radionuclide and ultrasound examinations. No statistically significant difference existed between ultrasonography and radionuclide in detecting MD with bloody stool(P>0.05). Conclusion s The clinical manifestations of MD are often non-specific and bloody stool is predominant. Ultrasound examination has a high specificity for diagnosing of MD with bloody stool. And radionuclide examination may improve accuracy. For MD with intestinal obstruction and diverticulitis, ultrasound has a high diagnostic accordance rate for various complications so that the misdiagnostic rate of acute abdomen may be reduced.