Lin Xiao-Kun, Huang Xiao-Zhong, Bao Xiao-Zhou, Zheng Na, Xia Qiong-Zhang, Chen Cong-de
Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Department of Pediatric Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Medicine (Baltimore). 2017 Aug;96(32):e7760. doi: 10.1097/MD.0000000000007760.
Meckel diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract in children. The aim of this study was to review and analyze clinical data on the diagnosis and management of Meckel diverticulum in pediatric patients. The records of 102 pediatric patients (<14 years old) who underwent surgery for Meckel diverticulum at our institute between 2001 and 2015 were reviewed. Clinical, imaging, laboratory, surgical, and pathological data were recorded. The series comprised 65 males and 37 females with a median age of 5.6 years. Lower gastrointestinal bleeding was the most frequently identified clinical manifestation of Meckel diverticulum, and this manifestation was observed in 41 patients. Intussusception secondary to Meckel diverticulum was identified in 32 patients. Twelve patients presented clinical features of peritonitis; of these patients, 8 had perforated Meckel diverticulum and 4 had Meckel diverticulitis. In 10 patients, Meckel diverticulum was incidentally diagnosed during other surgeries, including appendectomy and neonatal enterostomy. Seven patients were diagnosed with intestinal obstruction. Technetium-99m pertechnetate imaging offered high diagnostic yield. Open surgery was performed on 59 patients, while a laparoscopic approach was employed in 35 patients. The remaining 8 patients did not undergo resection of the Meckel diverticulum. Histology revealed ectopic gastric mucosa in 42 patients (44.7%), ectopic pancreatic tissue in 35 patients (37.2%), mucosa of the small intestine in 15 patients (16.0%), and both gastric and pancreatic ectopic tissue in 2 patients (2.1%). All patients recovered uneventfully except 2 patients in whom an intestinal adhesion obstruction was identified after discharge. Meckel diverticulum had various clinical manifestations in children. Technetium-99m pertechnetate imaging may be useful for diagnosing Meckel diverticulum. Surgical excision of the Meckel diverticulum may be safe and effective in symptomatic patients, and relatively better outcomes can be achieved using this approach.
梅克尔憩室是儿童胃肠道最常见的先天性异常。本研究的目的是回顾和分析小儿梅克尔憩室诊断和治疗的临床资料。回顾了2001年至2015年间在我院接受梅克尔憩室手术的102例儿科患者（<14岁）的记录。记录了临床、影像、实验室、手术和病理数据。该系列包括65名男性和37名女性，中位年龄为5.6岁。下消化道出血是梅克尔憩室最常见的临床表现，41例患者出现此表现。32例患者诊断为梅克尔憩室继发肠套叠。12例患者出现腹膜炎临床特征；其中8例为梅克尔憩室穿孔，4例为梅克尔憩室炎。10例患者在其他手术（包括阑尾切除术和新生儿肠造口术）中偶然诊断出梅克尔憩室。7例患者诊断为肠梗阻。锝-99m高锝酸盐显像具有较高的诊断率。59例患者接受了开放手术，35例患者采用了腹腔镜手术。其余8例患者未切除梅克尔憩室。组织学检查显示，42例患者（44.7%）有异位胃黏膜，35例患者（37.2%）有异位胰腺组织，15例患者（16.0%）有小肠黏膜，2例患者（2.1%）有胃和胰腺异位组织。除2例患者出院后发现肠粘连梗阻外，所有患者均顺利康复。梅克尔憩室在儿童中有多种临床表现。锝-99m高锝酸盐显像可能有助于诊断梅克尔憩室。对于有症状的患者，手术切除梅克尔憩室可能是安全有效的，采用这种方法可取得相对较好的效果。
