麦克尔憩室出血的临床及病理分析

目的分析麦克尔憩室出血患者的临床和病理特点。方法对1993年4月-2010年3月在解放军总医院住院的经小肠镜和(或)手术确诊的55例麦克尔憩室出血患者进行临床和病理分析。结果患者中位年龄25岁,所有患者均为反复或持续出血,34.55%(19/55)慢性中小量出血患者突然出现1次或以上大出血。憩室距回盲瓣中位距离67cm,憩室中位长度3.5cm,87.27%(48/55)憩室为单发。32.73%(18/55)患者的麦克尔憩室存在溃疡,44.74%(17/38)患者有胃黏膜异位,5.26%(2/38)患者有异位胰腺组织,5.26%(2/38)患者合并有间质瘤。对上述不明原因的小肠出血患者进行口服小肠钡剂造影或全消化道钡剂造影、小肠插管钡灌肠检查、结肠镜检查、胶囊内镜检查、双气囊小肠镜检查9、9锝同位素扫描、肠系膜上动脉造影检查及术中肠镜检查等,分别有22.22%(2/9)9、0.91%(20/22)、33.33%(6/18)2、5.00%(2/8)8、2.21%(16/19)、88.89%(8/9)、9.09%(1/11)、100.00%(2/2)的患者明确了麦克尔憩室诊断。口服小肠钡剂造影发现憩室的阳性率显著低于小肠插管钡灌肠检查(P<0.001),胶囊内镜检查发现憩室的阳性率显著低于双气囊小肠镜检查(P<0.01)。87.18%(34/39)的患者行开腹手术治疗,12.82%(5/39)的患者行腹腔镜手术,术后均恢复良好并未再复诊。结论中国麦克尔憩室出血多见于青年,确诊前常被诊断为不明原因的消化道出血;憩室多为单发,距回盲瓣距离多为50~100cm;憩室内异位胃黏膜是导致溃疡、出血的主要原因;小肠插管钡灌肠检查9、9锝同位素扫描和小肠镜检查对诊断麦克尔憩室敏感高;手术切除疗效肯定。

Clinical and pathological analysis of hemorrhage from Meckel's diverticulum

Objective To analyze the clinical and pathological characters of patients with hemorrhage from Meckel's diverticulum,so as to obtain a deeper understanding and to improve the treatment of this condition.Methods From Apr.1993 to Mar.2010,55 inpatients were diagnosed as hemorrhage from Meckel's diverticulum by enteroscopy or/and surgery in General Hospital of PLA.The clinical and pathological data were then collected and retrospectively analyzed.Results All the patients,with median age of 25 years,presented r...