Robinson Jamie R, Correa Hernan, Brinkman Adam S, Lovvorn Harold N
Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
J Pediatr Surg. 2017 Oct;52(10):1610-1615. doi: 10.1016/j.jpedsurg.2017.03.047. Epub 2017 Mar 23.
Meckel diverticula containing gastric heterotopia predispose to local hyperacidity, mucosal ulceration, and gastrointestinal bleeding in children. Eradication of acid-producing oxyntic cells is performed by either of two surgical methods: segmental enterectomy including the diverticulum or diverticulectomy only.
Retrospective review of all children having surgical resection of a Meckel diverticulum at a tertiary-referral children's hospital from 2002 to 2016 was performed. Demographic data, surgical method, pathological specimens, and outcomes were evaluated.
102 children underwent surgical resection of a Meckel diverticulum during the study period. 27 (26.5%) children presented with bleeding, of which 16 (59%) had diverticulectomy only, and 11 (41%) had segmental ileal resection. All Meckel diverticula in children presenting with bleeding contained gastric heterotopia, and resection margins were free of gastric mucosa. Histologically, 19 specimens showed microscopic features of ulceration, on average 2.95mm (SD 4.49) from the nearest gastric mucosa (range: 0-16mm). Mean length of hospitalization after ileal resection was 4.0days (SD 1.2) compared to 1.6days (SD 0.9) for diverticulectomy only (p<0.001), with no re-bleeding occurrences.
In the operative management of children having a bleeding Meckel diverticulum, diverticulectomy-only completely eradicates gastric heterotopia without increased risk of continued bleeding or complications and significantly shortens hospitalization.
Treatment Study: Level III.
含有胃异位组织的梅克尔憩室易导致儿童局部胃酸过多、黏膜溃疡和胃肠道出血。通过两种手术方法之一可根除产酸的壁细胞：包括憩室的节段性肠切除术或仅行憩室切除术。
对2002年至2016年在一家三级转诊儿童医院接受梅克尔憩室手术切除的所有儿童进行回顾性研究。评估人口统计学数据、手术方法、病理标本和结果。
在研究期间，102名儿童接受了梅克尔憩室手术切除。27名（26.5%）儿童出现出血，其中16名（59%）仅接受了憩室切除术，11名（41%）接受了节段性回肠切除术。所有出血儿童的梅克尔憩室均含有胃异位组织，切除边缘无胃黏膜。组织学上，19个标本显示溃疡的微观特征，距最近的胃黏膜平均2.95mm（标准差4.49）（范围：0 - 16mm）。回肠切除术后的平均住院时间为4.0天（标准差1.2），而仅行憩室切除术的平均住院时间为1.6天（标准差0.9）（p<0.001），且无再次出血情况发生。
在对有出血性梅克尔憩室的儿童进行手术治疗时，仅行憩室切除术可完全根除胃异位组织，且不会增加持续出血或并发症的风险，并显著缩短住院时间。
治疗研究：III级。
