Redman E P, Mishra P R, Stringer M D
Department of Paediatric Surgery, Level 3 CSB, Wellington Children's Hospital, Riddiford St, Newtown, Wellington, 6021, New Zealand.
Department of Paediatrics and Child Health, Wellington School of Medicine, University of Otago, Wellington, 6021, New Zealand.
Pediatr Surg Int. 2020 Aug;36(8):869-874. doi: 10.1007/s00383-020-04673-5. Epub 2020 May 20.
Recent reports have recommended laparoscopic diverticulectomy for symptomatic Meckel diverticulum (MD) rather than laparoscopic-assisted extracorporeal resection. This technique may risk leaving residual ectopic mucosa leading to complications. This systematic review attempts to quantify the relative risks of both approaches. A systematic review was conducted according to PRISMA guidelines. Articles were eligible for inclusion if they reported data on the laparoscopic management of symptomatic MD in children. Eleven reports were identified, all of which were institutional retrospective studies. Pooled outcome data on 248 children showed no statistically significant difference in complications between laparoscopic diverticulectomy (n = 133) and laparoscopic-assisted segmental resection (n = 115) (3% vs. 6.1%, p = 0.39). One patient from the diverticulectomy group re-presented with recurrent bleeding necessitating segmental small bowel resection. Conclusions are limited by the number of patients and variable follow up. Short, wide MD with a height:base ratio of < 2; diverticula with thickening or ischemia at the base and those complicated by volvulus or small bowel obstruction are probably best treated by laparoscopic-assisted extracorporeal resection. For other symptomatic diverticula laparoscopic diverticulectomy is a reasonable approach with a less than 1% risk of leaving residual ectopic gastric mucosa.
近期报告推荐对有症状的梅克尔憩室（MD）行腹腔镜憩室切除术，而非腹腔镜辅助体外切除术。该技术可能有残留异位黏膜导致并发症的风险。本系统评价试图量化两种方法的相对风险。根据PRISMA指南进行系统评价。如果文章报告了儿童有症状MD的腹腔镜治疗数据，则符合纳入标准。共识别出11篇报告，均为机构回顾性研究。对248例儿童的汇总结局数据显示，腹腔镜憩室切除术（n = 133）与腹腔镜辅助节段性切除术（n = 115）之间的并发症无统计学显著差异（3%对6.1%，p = 0.39）。憩室切除术组有1例患者再次出现复发性出血，需要行节段性小肠切除术。结论受患者数量和随访差异的限制。高度与底部比值<2的短而宽的MD；底部增厚或缺血的憩室以及并发肠扭转或小肠梗阻的憩室可能最好采用腹腔镜辅助体外切除术治疗。对于其他有症状的憩室，腹腔镜憩室切除术是一种合理的方法，残留异位胃黏膜的风险小于1%。
