梅克尔憩室诱发儿童闭袢性肠梗阻的诊治体会

目的分析梅克尔憩室引起儿童急性闭袢性肠梗阻患儿的临床资料,为及时救治提供经验。方法回顾本院自2006年3月至2014年10月收治的儿童腹腔内闭袢性肠梗阻的临床资料,就梅克尔憩室引起急性肠扭转、压迫形成闭袢性肠梗阻病例的病因、发病时间、临床表现、手术方式、术中发现及预后等进行分析。结果 8年间,收治腹腔内闭袢性肠梗阻患儿共37例,其中梅克尔憩室引起者9例。在梅克尔憩室引起的闭袢性肠梗阻中,男性6例,女性3例;平均发病年龄6.5岁,开放手术6例,腹腔镜手术3例。术中证实梅克尔憩室与周围组织粘连形成闭袢7例;肠扭转2例,其中1例为梅克尔憩室引起并伴肠坏死;另1例为纤维索带引起。术中行肠管复位,肠切除肠吻合或纤维索带切除术,术后1例出现粘连性肠梗阻,保守治疗无好转行再手术。所有患儿术后恢复良好,痊愈出院,随访12个月至8年未见异常。结论梅克尔憩室是引起儿童急性闭袢性肠梗阻的主要病因之一,学龄前后期发病多见,病情进展迅速,术前确诊困难,需早期探查,挽救肠管。

Diagnosis and treatment of closed-loop intestinal obstruction due to Meckel diverticulum in children

Objetive To improve the capabilities of early diagnosis and prognosis of children with closed-loop intestinal obstructions due to Meckel diverticulum. Methods The clinical data were reviewed for patients with closed-loop intestinal obstruction due to Meckel diverticulum from March 2006 to October 2014. Their etiology,time of onset,manifestations,surgical approach,intraoperative findings and prognosis were an-alyzed. Results Among 37 cases of closed-loop intestinal obstruction,9 were caused by Meckel diverticu-lum.There were 6 boys and 3 girls.The average age was 6.5 years.Open (n =6)and laparoscopic (n =3) approaches were used.The causes of closed-loop intestinal obstruction were confirmed intraoperatively.Seven cases developed strangulated obstruction of compression from diverticular adhesion to abdominal wall or small intestine.Two cases developed acute vovulus,one is from diverticulum which led to intestinal necrosis and the other is from fibrous cord.Related bowel or fibrous band resection and intestinal anastomosis were performed. All cases recovered well,except for 1 case of intestinal adhesion undergoing adhesiolysis.A follow-up period of 12 months to 8 years was uneventful. Conclusions Closed-loop intestinal obstruction due to Meckel diverticu-lum is common in pre-school children.Disease progression is rapid.Early abdominal exploration should be per-formed urgently to rescue bowels and save lives.