Lüdtke F E, Mende V, Köhler H, Lepsien G
Department of General Surgery, University of Göttingen, Federal Republic of Germany.
Surg Gynecol Obstet. 1989 Dec;169(6):537-42.
During the last 27 years, 84 patients with Meckel's diverticulum (MD) have undergone resection at our institution (incidental findings, n = 50; MD with complications, n = 34). The most frequent complications of MD were obstruction and diverticulitis. Analysis of records of patients revealed that MD is a rare intraoperative finding. The calculated incidence was 2.4 per cent, and the ratio of diverticulectomy to appendectomy was 1:55. A preoperative diagnosis of MD was rare (4 per cent). Only in those patients with hemorrhage were diagnostic procedures (angiography, scintigraphy and roentgenography) useful. Ectopic tissues occurred in 23 per cent of all patients and were observed more often in patients with complications of MD. There was a correlation between hemorrhage and gastric heterotopic tissue. Another correlation was found between invagination and pancreatic tissue as well as diverticulitis. Postoperative adhesions causing ileus was the main complication found after resection for MD (8 per cent), whereas no other severe complications were observed (no insufficiency). There was no death as a result of resection. Because of the low rate of postoperative complications and the latent risk of complications arising sometime during life in sporadic episodes, a prophylactic resection is indicated but is often performed too late because the primary endangered group for complications is children who are less than two years of age. Predominantly in those with hemorrhage, the base of the diverticulum should be carefully checked for heterotopic tissue to prevent further complications.
在过去27年中，我院有84例梅克尔憩室（MD）患者接受了切除术（偶然发现，n = 50；伴有并发症的MD，n = 34）。MD最常见的并发症是梗阻和憩室炎。对患者记录的分析显示，MD是一种罕见的术中发现。计算得出的发病率为2.4%，憩室切除术与阑尾切除术的比例为1:55。MD的术前诊断很少见（4%）。仅在那些有出血的患者中，诊断性检查（血管造影、闪烁扫描和X线检查）才有用。异位组织出现在所有患者中的比例为23%，在伴有MD并发症的患者中更常见。出血与胃异位组织之间存在相关性。还发现肠套叠与胰腺组织以及憩室炎之间存在相关性。MD切除术后导致肠梗阻的术后粘连是主要并发症（8%），而未观察到其他严重并发症（无功能不全）。切除术后无死亡病例。由于术后并发症发生率低，且在散发性发作的一生中某个时候可能出现潜在的并发症风险，因此建议进行预防性切除，但往往实施得太晚，因为并发症的主要危险人群是两岁以下的儿童。主要是在那些有出血的患者中，应仔细检查憩室底部是否有异位组织，以防止进一步的并发症。
