Loh J-C, Kruschewski M, Buhr H-J, Lehmann K S
Chirurgische Klinik I, Charité - Campus Benjamin Franklin, Berlin, Deutschland.
Zentralbl Chir. 2014 Aug;139(4):452-9. doi: 10.1055/s-0032-1327963. Epub 2013 Mar 4.
Meckel's diverticulum (MD) is the most common diverticulum of the small bowel and an important finding in surgical practice. The aim of this study was to assess the safety of the resection of symptomatic and asymptomatic MD concerning postoperative complications. As MD are relatively rare, an overview of the literature is given.
All patients with MD at the department at general surgery of the Charité - Campus Benjamin Franklin between 1996 and 2010 were assessed. An analysis for symptomatic and incidental MD was performed for incidence, indication, intraoperative findings, histology and postoperative outcome.
An MD was intraoperatively found in 71 of 29 682 patients (0.2 %). Of these, a symptomatic MD occurred in 26 patients (37 %). A symptomatic MD was causal in 6 of 7 patients with gastrointestinal bleeding (GIB, p = 0.005). All symptomatic MD and 30 (67 %) asymptomatic MD were resected. Ectopic gastric mucosa was found significantly more frequently in patients with symptomatic MD (p = 0.001). Patients with asymptomatic MD and resection had less complications as a trend (p = 0.057).
Ectopic mucosa is more frequent in symptomatic MD, especially in bleeding MD. MD should always be considered in GIB of unknown origin. Resection of incidental MD can be recommended in patients without contraindications such as peritonitis, cancer, ascites or immunosuppression.
梅克尔憩室（MD）是小肠最常见的憩室，也是外科手术中的一项重要发现。本研究的目的是评估有症状和无症状MD切除术后并发症的安全性。由于MD相对少见，因此给出了文献综述。
对1996年至2010年间在夏里特医院本杰明·富兰克林校区普通外科就诊的所有MD患者进行评估。对有症状和偶然发现的MD进行发病率、适应证、术中发现、组织学及术后结果分析。
在29682例患者中，术中发现71例MD（0.2%）。其中，26例（37%）为有症状MD。在7例胃肠道出血（GIB）患者中，6例有症状MD是病因（p = 0.005）。所有有症状MD和30例（67%）无症状MD均被切除。有症状MD患者中异位胃黏膜的发现频率显著更高（p = 0.001）。无症状MD且接受切除的患者并发症较少，呈趋势性（p = 0.057）。
有症状MD中异位黏膜更常见，尤其是出血性MD。不明原因的GIB应始终考虑MD。对于无腹膜炎、癌症、腹水或免疫抑制等禁忌证的患者，可建议切除偶然发现的MD。
