Lequet J, Menahem B, Alves A, Fohlen A, Mulliri A
Service de chirurgie viscérale et digestive, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.
Service de chirurgie viscérale et digestive, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Normandie, UNICAEN, CHU de Caen, inserm UMR1086, centre François-Baclesse, 3, avenue du Général-Harris, 14045 Caen cedex, France.
J Visc Surg. 2017 Sep;154(4):253-259. doi: 10.1016/j.jviscsurg.2017.06.006. Epub 2017 Jul 9.
Meckel's diverticulum (MD) is the most common gastro-intestinal congenital malformation (approximately 2% in the overall population). The lifetime risk of related complications is estimated at 4%. These include gastro-intestinal bleeding, obstruction or diverticular inflammation. Diagnosis is difficult and rarely made, and imaging, especially in the case of complicated disease, is often not helpful; however exploratory laparoscopy is an important diagnostic tool. The probability of onset of complication decreases with age, and the diagnosis of MD in the adult is therefore often incidental. Resection is indicated in case of complications but remains debatable when MD is found incidentally. According to an analysis of large series in the literature, surgery is not indicated in the absence of risk factors for complications: these include male gender, age younger than 40, diverticulum longer than two centimetres and the presence of macroscopically mucosal alteration noted at surgery. Resection followed by anastomosis seems preferable to wedge resection or tangential mechanical stapling because of the risk of leaving behind abnormal heterotopic mucosa.
梅克尔憩室（MD）是最常见的胃肠道先天性畸形（在总人口中约占2%）。相关并发症的终生风险估计为4%。这些并发症包括胃肠道出血、梗阻或憩室炎。诊断困难且很少能做出，影像学检查，尤其是在复杂疾病的情况下，往往并无帮助；然而，探查性腹腔镜检查是一种重要的诊断工具。并发症的发病概率随年龄增长而降低，因此成人MD的诊断往往是偶然的。出现并发症时需进行切除，但偶然发现MD时是否切除仍存在争议。根据文献中对大量病例系列的分析，无并发症危险因素时不建议手术：这些危险因素包括男性、年龄小于40岁、憩室长度超过两厘米以及手术中发现的肉眼可见的黏膜改变。由于存在遗留异常异位黏膜的风险，切除后吻合术似乎比楔形切除或切线机械吻合更可取。
