腹腔镜辅助Meckel憩室切除术

目的:探讨Meckel憩室的腹腔镜诊断及治疗方法。方法:总结分析2002年6月至2008年6月我们用腹腔镜诊断治疗Meckel憩室35例患者的临床资料。35例均于腹腔镜下找到憩室后结扎切除或延长脐部切口腹腔外切除吻合。结果:Meckel憩室并下消化道出血25例(71.4%),反复脐周或右下腹痛6例(17.1%),肠梗阻4例(11.5%)均治愈出院。术中腹腔镜探查确诊16例,占45.7%。手术时间45～90min,平均70min,平均住院时间5.6d。结论:腹腔镜辅助Meckel憩室切除术患者创伤小、疼痛轻、康复快,是诊断治疗Meckel憩室的良好方法。     

腹腔镜诊治儿童美克尔憩室出血

目的研究腹腔镜在儿童Meckel憩室出血诊断和治疗中的应用。方法分析近年来采用腹腔镜治疗的Meckel憩室出血病例31例,男19例,女12例。结果腹腔镜治疗31例Meckel憩室中1例因粘连广泛改行开腹手术,合并肠重复畸形1例,肠套叠2例。其中楔形切除吻合12例,肠切除端-端吻合18例。同时进行了3例阑尾及4例斜疝的联合手术。结论腹腔镜的应用为儿童Meckel憩室出血的诊断和治疗提供了一条极好的途径,具有诊断和治疗的双重作用。提高了疾病的诊断率,减少了并发症的发生率,降低了医疗费用。     

成人美克耳憩室49例诊治分析

目的探讨成人美克耳憩室的临床表现、诊断及治疗方法,以提高成人美克耳憩室的诊治水平。方法对我院1995年4月~2005年4月收治的成人美克耳憩室49例的临床资料进行回顾性分析。本组病人均经手术治疗。其中,行憩室切除加小肠部分切除32例,憩室切除加小肠楔形切除11例,腹腔镜辅助憩室切除加小肠部分切除6例。结果本组病例病理检查结果显示,美克耳憩室内有异位胃组织者21例,有异位胰腺组织者2例。本组病例均治愈出院。随访6月~10年,疗效满意。结论成人美克耳憩室主要表现为下消化道出血、急性憩室炎或小肠梗阻,无论有无临床症状,一经确诊,均以手术治疗为宜。腹腔镜可作为诊断和治疗成人美克耳憩室引起消化道出血的常规方法。     

Carcinoid tumor in Meckel's diverticulum: laparoscopic treatment and review of the literature

Meckel's diverticulum is a common anomaly of the small intestine that occurs in approximately 2% of the population, often found incidentally at the time of abdominal exploration. Carcinoid tumors in a Meckel's diverticulum have been reported in only 111 cases. The author describes a patient who presented for elective cholecystectomy and who during laparoscopy was found to have an abnormal-appearing ileal diverticulum. The resected specimen contained a carcinoid tumor. The decision-making process in treating these patients is reviewed along with a discussion of the laparoscopic treatment of intra-abdominal pathologic conditions found incidentally at the time of elective surgery.     

手术治疗Meckel’s憩室20例

目的　提高对Meckel’s憩室的诊治水平。方法　回顾性总结经手术及病理证实的Meckel’s憩室 2 0例 ,14例因并发症手术 ,6例在其他手术中发现。结果　 15例行单纯楔形切除 ,5例行肠切除吻合术。术后无并发症发生。结论　Meckel’s憩室属先天性畸形 ,术前不易诊断。其并发症发生率约为 4% ,依次为 :憩室炎 (常合并出血 ) ,肠套叠 ,嵌顿疝 ,肿瘤等 ,手术治疗效果好。     

Fishbone perforation through a Meckel's diverticulum: a rare laparoscopic diagnosis in acute abdominal pain.

The use of diagnostic laparoscopy in acute abdominal pain, especially when patients have been admitted for acute pain in the lower abdominal quadrants, improves the accuracy of diagnosis and leads to improvements in treatment procedures. A case is reported of a 24-year-old woman admitted under suspicion of appendicitis. The appendix was found to be normal, and a perforation caused by a fishbone was discovered in a Meckel's diverticulum. The diverticulum was resected by a combined laparoscopic and open procedure. Diagnostic laparoscopy should be performed routinely in cases of acute abdominal pain in the lower quadrants of suspected appendiceal origin to avoid overlooking other causes of the symptoms.     

Meckel's diverticulum in laparoscopic era

A recent case of a Meckel's diverticulum diagnosed and successfully laparoscopically treated, triggered off a retrospective study on a series of 34 cases with Meckel's diverticulum admitted to the First Surgical Clinic between 1990-2003. We encountered 12 uncomplicated cases and 22 cases with a large panel of complications: 11 intestinal obstructions (volvulus 9, intussusceptions on a tumor-2), 9 cases with diverticulitis, 1 gastrointestinal bleeding and 1 case with Littre's inguinal hernia. Positive diagnosis was established intraoperatively and the surgical treatment was adapted according to the local situation (excision of the diverticulum or enterectomy). Out of 12 patients with uncomplicated Meckel's diverticulum 8 were subjected to prophylactic excision of the diverticulum. In 6 of these microscopic examinations were inclusions of gastric mucosa. Laparoscopy is safe, relatively inexpensive and efficient in the diagnosis and treatment of Meckel's diverticulum.     

Meckel's diverticulum causing cecal volvulus

Meckel's diverticulum is present in 2 per cent of the population with bowel obstruction as its most common complication. This case report describes an extremely rare complication of a Meckel's diverticulum, a cecal volvulus. The diagnosis of cecal volvulus was made preoperatively on abdominal X-rays; the diagnosis of a Meckel's diverticulum was made intraoperatively. The cecum was found to be twisted around a vitelline band on a broad-based Meckel's diverticulum extending to the umbilicus. The diverticulum was resected. The patient did well postoperatively and was discharged without any difficulty.     

Meckel's diverticulum: a disease associated with a colored clinical picture

Meckel's diverticulum is reported in only 1 or 2% of the population. In most cases, it is free of clinical symptoms. The diagnostic modalities are effective in only 60-70% of all cases. The diagnostic laparoscopy is a safe and effective method for patients suffering from unclear abdominal pain with the option of a definitive surgical therapy. We describe the case of a 10-year-old girl with recurrent abdominal pain caused by a chronic subileus due to a Meckel's diverticulum in combination with a fibrous cord from the base of diverticulum to the mesenterial root. Both were resected in a laparoscopic technique.     

Inverted Meckel's diverticulum: Two case reports and a review of the literature

Gastrointestinal surgeons seldom encounter inverted Meckel's diverticulum in their clinical practice. We describe two cases of inverted Meckel's diverticulum. If the patient has a disease-related complication such as intussusception, as with our first case, it can be easily detected. However, if the patient has subacute or chronic symptoms, as with our second case, the diagnosis might be delayed. Regardless of the diseaserelated complication, intussusception of inverted Meckel's diverticulum can be easily managed with laparoscopic single-port surgery.     

Meckel's diverticulum in a strangulated femoral hernia. Case report and review of literature

Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. In the vast majority of cases it remains asymptomatic throughout life but in about 5% of cases it gives rise to complications, namely, haemorrhage, intestinal obstruction and inflammation. A rare complication is being presented--a femoral hernia containing a strangulated Meckel's diverticulum. This is known as Littre's hernia, which often exhibits subtle variations from the norm in its presentation. Preoperative diagnosis of Littre's hernia containing Meckel's diverticulum is rather difficult; almost always, the strangulated diverticulum is first discovered during operation. The diverticulum was resected and the femoral canal closed by a polypropylene mesh plug. The patient underwent an uneventful recovery and was discharged home on the fourth postoperative day. Complications arising from Meckel's diverticulum usually occur at a young age, with the ectopic tissue present in the diverticulum frequently being the cause of the symptoms. Criteria for the resection of Meckel's diverticulum found incidentally at laparotomy have been suggested.     

One-trocar transumbilical laparoscopic-assisted management of Meckel's diverticulum in children

PURPOSE: Transumbilical laparoscopic-assisted intestinal surgery using only "one trocar" is a very minimal invasive procedure. The authors present their experience for the management of Meckel's diverticulum. MATERIALS AND METHODS: Between January 2001 and December 2004, 9 transumbilical laparoscopic-assisted procedures were performed for Meckel's diverticulum. The median age of the patients was 6.1 years (range, 6 months-13.6 years). Six patients were admitted for intestinal bleeding and technetium-99m pertechnetate scan was positive in 3. Three patients had recurrent abdominal pain and abdominal ultrasound scan showed a cystlike structure. An intraumbilical Hasson 10-mm trocar was inserted in an open fashion. Using a 10-mm operative laparoscope, the terminal ileum was grasped with an atraumatic instrument and exteriorized through the umbilicus. Ileal exploration and treatment were performed extracorporeally. RESULTS: Meckel's diverticulum was identified in 8 patients and ileal duplication in 1 patient: intestinal resection/anastomosis (n = 7) or excision of diverticulum (n = 2) was performed. There were no operative complications. Median hospital stay was 4 days (range, 3-7 days). At a median followup of 24 months (range, 3-51 months), all patients are asymptomatic. CONCLUSION: Our results indicate that the one trocar transumbilical laparoscopic-assisted procedure is safe and effective for the diagnosis and treatment of Meckel's diverticulum, with excellent cosmetic results.     

有并发症的成人Meckel憩室的急诊手术治疗:附29例报告

目的 探讨成人Meckel憩室并发症的临床特点，诊断和治疗。方法 回顾性分析急诊手术的29例成人Meckel憩室的临床资料。结果 18—30岁的患者占79．3％。憩室出血12例(41．4％)，急性化脓性憩室炎9例(31．0％)，憩室穿孔6例(20．7％)，憩室致肠梗阻2例(6．9％)。术前经小肠造影结合^99mTcO4-r核素扫描明确诊断4例(13．8％)，误诊25例(81．2％)。29例均行手术治疗，28例治愈，1例死亡。结论 成人Meckel憩室并发症容易误诊为阑尾炎等疾病。对下腹疼痛病人，尤其是年轻患者，若有下消化道出血，应想到Meckel憩室的可能性。小肠造影结合核素扫描是诊断憩室及憩室出血的有效方法。有并发症的Meckel憩室应尽早手术．并选择适当的手术方式。     

腹腔镜诊治小儿美克尔憩室的临床价值

目的 :探讨腹腔镜对小儿美克尔憩室 (MD)并出血的诊断及治疗价值。方法 :1997年 6月至2 0 0 2年 4月对美克尔憩室 13例行腹腔镜憩室切除术。 13例患儿均有间歇性便血史 ,术前99mTc扫描 ,8例在右下腹显示放射物聚集 ,5例阴性。结果 :全组术后恢复顺利 ,随访 6月～ 2年 ,未再便血 ,生长发育正常。结论 :与传统的开腹手术相比 ,腹腔镜手术具有切口小 ,患者康复快 ,能直接进行诊断及治疗 ,术后并发症少等优点。有条件的医院可将其作为有症状的MD患儿的常规治疗方法。     

High incidence of symptomatic Meckel's diverticulum in patients less than fifty years of age: an indication for resection

Meckel's diverticulum is a congenital diverticulum of the small intestine. Complications include perforation, inflammation, bleeding, obstruction, and volvulus. Resection of asymptomatic Meckel's diverticula [corrected] has been recommended; however, indications are not well defined. To delineate indications to resect asymptomatic Meckel's diverticulum, the charts of 16 men and 13 women, mean age 55.1 +/- 23 years, confirmed at surgery with Meckel's diverticula [corrected] were retrospectively reviewed. Two groups were identified: symptomatic resected (9); asymptomatic (20), which included resected (10) or not resected (10). The age ranges, male:female (M:F) ratios, the height:diameter ratios, heterotopic tissue, surgical management, and complications were recorded and compared. The average age for symptomatic resection was 34.9 +/- 23.2 years compared with 64.2 +/- 16.5 years for asymptomatic patients (P = 0.0006). Of patients under 50 years of age, 70 per cent (7/10) were symptomatic compared with 10 per cent (2/19) of those over 50 years of age. Overall, the M:F ratios between the groups were similar, and the average M:F ratio was 1.23:1. Surgical management of resected Meckel's diverticula [corrected] included 10 segmental resections and 10 diverticulectomies; one of each was laparoscopic. There were no differences in the complication rate, nor in outcomes between the groups. Heterotopic tissue was only identified in symptomatic patients, 33 per cent (3/9) versus 0 per cent (0/10) in resected asymptomatic patients. The height:diameter ratios were similar between the groups. Adult patients with symptomatic Meckel's diverticula [corrected] were more likely to be under the age of 50 and to have heterotrophic tissue. Resection of asymptomatic Meckel's diverticulum should be considered in patients under 50 years of age; patients over age 50 years of age will be less likely to benefit from prophylactic resection.     

腹腔镜辅助经脐“Z”形切口治疗小儿美克尔憩室

目的探讨腹腔镜辅助下经脐＂Z＂形切口小儿美克尔憩室切除术的可行性。方法 2010年6月～8月,采用两孔法腹腔镜经脐孔＂Z＂形切口对6例小儿美克尔憩室行切除术。于脐孔及左下腹分别置入5 mm trocar,探查找到憩室后,延长脐部切口成＂Z＂形,将憩室提出腹腔外行切除吻合。结果 6例均顺利完成经脐＂Z＂形切口腹腔镜辅助手术,无中转开腹手术。术后4 d进食流质,5～8 d出院。无脐疝、肠瘘及肠梗阻等并发症发生。结论经脐＂Z＂形切口腹腔镜辅助切除小儿美克尔憩室具有创伤小、切口更加隐蔽、美容效果好等优点,安全可行。     

脂肪肝电视腹腔镜诊断与病理诊断相关性研究

目的 :探索腹腔镜诊断脂肪肝与病理诊断脂肪肝相关性。方法 :利用腹腔镜的直观性 ,在行腹腔镜胆囊切除手术时 ,对术前B超诊断为脂肪肝的 6 3例患者 ,做出腹腔镜下脂肪肝的诊断 ,并对肝脏进行图像采集 ,然后在肝表面切取小块肝组织进行病理检查 ,将病理结果与腹腔镜下诊断进行对比。结果 :腹腔镜诊断为轻度脂肪肝 2 2例 ,中度 2 9例 ,重度 8例 ,不是脂肪肝 4例。病理诊断为轻度脂肪肝 2 3例 ,中度 2 8例 ,重度 10例 ,有 2例不是脂肪肝 ,统计学分析显示 ,腹腔镜诊断脂肪肝与病理诊断脂肪肝符合率达 90 4 8%。结论 :腹腔镜可作为一种新的、直观的诊断脂肪肝方法。     

Adenocarcinoma of Meckel's diverticulum

A case of adenocarcinoma of Meckel's diverticulum is reported. Small bowel neoplasias are the least frequent in the gastrointestinal tract and localization to the diverticulum is extremely rare. Among histological types, adenocarcinoma accounts for the minority of cases. Early diagnosis is difficult because of lack of specificity of signs and symptoms, except in advanced stages. Small bowel resection with lymphadenectomy is the recommended therapeutic approach. Although, in reported case it could not be performed, because of the diffuse intraabdominal metastasis at diagnosis. This and similar cases would open the discussion about a possible indication for prophylactic resection of Meckel's diverticulum. No definitive conclusion can be drawn at present since no follow-up study is available on the natural history of diverticula which have been observed during abdominal surgery and have not been resected.     

Laparoscopic management of Meckel's diverticulum

We present our observations on two young patients with repeated digestive bleeding from hemorrhagic Meckel's diverticulum. In one patient examined by Tc99 scintigraphy, the hemorrhagic area was shown in the lower abdomen. The laparoscopic exploration showed the Meckel's diverticulum at 1 m distance from ileocecal angle. Both cases were treated by resection with a vascular stapler postoperative evolution was favorable.     

Meckel's diverticulum: a neglected (or deliberately ignored) entity

Meckel's diverticulum is the most common of all the possible abnormalities that incomplete obliteration of the omphalo-mesenteric duct can produce. Often it is not sought during surgery performed for other abdominal diseases, e.g. cases of appendicitis. In these situations searching for and treating Meckel's diverticulum may be regarded as simply a waste of time or unjustified because its surgical treatment is not a completely safe procedure. In our opinion the systematic search for, and treatment of, Meckel's diverticulum during surgery performed for other abdominal conditions should always be performed. Elective resection of the diverticulum is characterised by fewer postoperative complications than emergency surgery. Laparoscopy would appear to be safe and effective in the treatment of this pathology, even in cases of severe diverticulitis. We report on our last five years' experience with the surgical treatment of this rare pathology, mainly occurring in previously appendectomised patients. One aim of this study was to demonstrate the possible benefits of the laparoscopic approach, focussing attention on the advisability of searching for and resecting Meckel's diverticulum when discovered incidentally during abdominal interventions performed for other pathologies.