要重视对美克尔氏憩室的诊治

我科1958～1981年经手术证实的62例美克尔氏憩室,术前诊为急性阑尾炎32例,阑尾穿孔腹膜炎13例,肠梗阻8例,消化道出血3例,病因不清剖腹探查发现5例。61例中仅有2例术前考虑到可能有美克尔氏憩室存在。手术证实由憩室所致小肠梗阻9例,憩室大出血3例,憩室穿孔致腹膜炎6例,憩室明显炎症改变24例;另19例无明显改变。61例憩室均在距回盲部100cm之内,1.5×1～9×2cm大小不等。其中4例是阑尾切除术后出现症状,二次手术时确诊,其中3例系憩室致肠梗阻,1例为憩室穿孔致腹膜炎。61例中,8例行肠切除,53例行憩室切除。     

单孔微型腹腔镜美克尔憩室楔形切除术的临床体会(附22例报告)

目的:总结单孔微型腹腔镜美克尔憩室楔形切除术的临床经验。方法:回顾分析2015年7月至2017年6月为22例患儿行腹腔镜美克尔憩室楔形切除术的临床资料。结果:21例患儿一期治愈,1例因一期手术行阑尾切除术,术后患儿出现腹痛、腹胀等肠梗阻症状,再次腹腔镜探查发现美克尔憩室,并在腹腔镜下切除。22例患儿无一例中转开腹,无肠瘘、肠梗阻、血便、肠间脓肿形成、切口疝等并发症发生,切口基本不留疤痕。手术时间40~50 min,平均(45±3)min;术中出血量3~5 ml,平均(4.0±0.7)ml;住院5~7 d,平均(6.0±0.7)d。术后随访4~12个月,平均(8±2)个月。结论:单孔微型腹腔镜美克尔憩室楔形切除术操作简单,安全可行,并发症少,对于术前腹痛诊断困难病例优势明显,值得临床推广。     

绞窄性肠梗阻的诊治进展

肠梗阻仍然是外科常见的急腹症,约占20％,其发生率仅次于急性阑尾炎。肠梗阻后部分病人可能发生肠绞窄坏死,最终影响病人的生存质量,甚至发生生命危险。据报道,机械性肠梗阻发生绞窄和肠坏死的分别为66．7％和41％。因此,如何尽快明确梗阻原因、早期发现绞窄性肠梗阻的表现,尽快采取有效措施、选择合适的手术时机是关系到肠梗阻最终结局的关键环节。     

门静脉高压症肠系膜静脉血栓形成致绞窄性肠梗阻的诊治体会

目的 总结因门静脉高压症引起的肠系膜静脉血栓形成致绞窄性肠梗阻的诊断和治疗经验.方法 我院自1993-2004年间共收治绞窄性肠梗阻154例,其中因门静脉高压症肠系膜静脉血栓形成致绞窄性肠梗阻11例,对其诊断和治疗作一回顾性分析.结果 11例患者均出现不同程度的恶心、呕吐、上腹部胀痛,仅7例出现剧烈腹痛,5例出现不明原因的发热.所有患者均行手术治疗并证实为绞窄性肠梗阻,病因均为门静脉高压症所致的肠系膜静脉血栓形成,其中2例为保守治疗24 h后未见明显好转而剖腹探查时发现.行部分小肠切除8例,3例术中发现肠系膜广泛血栓形成而放弃手术.术后死亡5例,3例为广泛血栓形成患者,2例为小肠部分切除术后发生肝功能衰竭死亡.结论 门静脉高压症肠系膜静脉血栓形成所致的急性绞窄性肠梗阻起病隐匿,常导致诊断困难而延误病情.     

高频超声对小儿美克尔憩室的诊断价值

目的探讨高频超声对小儿美克尔憩室的诊断价值。方法回顾性分析15例经手术证实的小儿美克尔憩室及其并发症(憩室炎、溃疡出血、穿孔、肠梗阻)超声特点及临床资料。结果与手术病理结果对照,高频超声对小儿美克尔憩室及其并发症的诊断符合率为73.3%(11/15)、误诊4例。结论高频超声对早期诊断小儿美克尔憩室及其并发症具有重要价值。     

结核性肠梗阻68例手术治疗体会

目的探讨结核性肠梗阻的手术治疗经验。方法回顾性分析2003年2月至2009年12月手术治疗的68例结核性肠梗阻的手术治疗情况。结果完全性梗阻52例,其中,回盲部结核19例(致回肠穿孔10例),广泛粘连13例,粘连带绞窄肠管20例;不全性梗阻16例,其中,回盲部结核9例,粘连带绞窄肠管4例,肠粘连成角3例。手术治愈68例,13例广泛粘连性梗阻保守治疗6～15d无效,行剖腹探查术,术后并发肠瘘3例,经充分引流,抗结核及对症支持治疗1个月后行肠切除肠吻合手术治愈;10例因粘连严重无法进腹,手术不能进行,再保守治疗1个月后行第二次手术治愈。结论不全性结核性肠梗阻,反复发作者,抗结核治疗至少3个月以上,方可手术。广泛粘连性完全性肠梗阻有效抗结核治疗至少1个月以上,方可行剖腹探查术。粘连带绞窄肠管和回盲部结核致完全梗阻、穿孔者,宜尽早手术。     

机械性和假性肠梗阻的临床鉴别要点和诊治体会

肠梗阻是腹部外科常见的急腹症，肠梗阻的分类按原因可大致分为机械性和非机械性，严重的绞窄性肠梗阻可导致腹膜炎和出血，危及生命，临床偶可发现少数病例为假性肠梗阻，此类病例应避免手术治疗，假性肠梗阻的定义最初来源于一些具有机械性肠梗阻的症状和体征的患者，但手术探查却未发现有梗阻的机械性原因。     

腹腔镜小切口辅助治疗小儿美克尔憩室45例

目的:探讨腹腔镜小切口辅助治疗小儿美克尔憩室的应用价值。方法:回顾性分析45例腹腔镜诊治美克尔憩室患儿的临床资料,总结手术步骤、小切口选择部位、手术时间、术后胃肠蠕动恢复时间及术后住院时间等数据。结果:35例行腹腔镜辅助下脐部、10例行右下腹小切口美克尔憩室切除术,45例术后均恢复良好,手术时间平均83 min(56~110min),术后平均进食时间为3.6 d(3~4 d),术后平均住院时间为7.2 d(6~9 d),术后随访无并发症。结论:腹腔镜在小儿美克尔憩室的诊治中兼具诊断和治疗的双重作用,腹腔镜辅助下小切口美克尔憩室切除术具有创伤小、痛苦小、术后恢复快、住院时间短、术后并发症低等明显优势,可作为小儿美克尔憩室治疗的首选方式。     

两孔法腹腔镜辅助下小儿美克尔憩室切除术

目的探讨两孔法腹腔镜辅助下小儿美克尔憩室切除术的可行性。方法2002年7月~2006年3月采用两孔法腹腔镜技术对13例小儿美克尔憩室行切除术。于脐环下缘及右下腹分别置入5mm trocar,探查找到憩室后,延长脐部切口,将憩室提出腹腔外行切除吻合。结果13例均顺利完成腹腔镜辅助手术,无中转开腹手术,手术时间40~70min,平均50min。术后24h肠功能恢复,术后3d进食流质,5~7d出院。13例随访6~48个月,平均13个月,无复发,无肠粘连、肠梗阻等远期并发症发生。结论两孔法腹腔镜辅助下小儿美克尔憩室切除术具有创伤小,术后病情恢复快,住院时间短,切口美观等诸多优点,安全可行。     

成年人Meckel憩室的腹腔镜微创手术探讨

目的探讨成人美克尔憩室(Meckel's diverticulum,Meckel憩室)的腹腔镜微创治疗方法,总结临床诊断和治疗体会。方法回顾性总结2003年1月~2014年1月我院收治的33例Meckel憩室患者临床资料,均行腹腔镜探查进一步明确诊断,并在腔镜辅助下切除Meckel憩室,总结分析术中所见、手术操作技巧和要点。结果 33例患者术中均证实Meckel憩室,距回盲部30~95 cm,平均68 cm。憩室出血23例(病理证实憩室粘膜出血水肿、多处点状坏死,合并胃粘膜病变14例,胰腺组织4例,憩室开口处间质瘤并溃疡1例);憩室炎13例,其中5例合并出血,2例合并穿孔;憩室合并肠扭转、肠梗阻2例。憩室部小肠部分切除吻合30例,憩室部肠管楔形切除3例。术后均获随访,3年以上21例,未再发生消化道出血或腹膜炎表现。结论腹腔镜探查是诊断Meckel憩室及其并发症的可靠方法,腔镜下实施切除是一种良好的微创治疗方法。     

Intestinal obstruction due to meckel's diverticulum: a rare presentation

Meckel's diverticulum occurs in about 1-3% of general population. The majority of them are asymptomatic and incidentally found at laparotomy. The most common complication due to Meckel's diverticulum in adults is intestinal obstruction. The frequency of symptoms decreases with age. Enteroliths are rarely formed in a Meckel's diverticulum and are known to cause intestinal obstruction. These should be considered in the differential diagnosis of radioopaque shadows in the plain abdominal films. We describe a rare presentation of Meckel's diverticulum in an elderly woman.     

Loop formation of Meckel's diverticulum causing small bowel obstruction in adults: report of two cases

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, and in the majority of cases it remains asymptomatic. The total lifetime rate of complications is 4%. It is an uncommon cause of intestinal obstruction in adults. Loop formation of Meckel's diverticulum leading to small bowel obstruction is an extremely rare event. We report two such cases in which the bowel became obstructed and strangulated in a loop formed by adhesion of the distal end of the Meckel's diverticulum to the proximal ileum and mesentery.     

Laparoscopy in diagnosis and management of Meckel's diverticulum

OBJECTIVE: The aim of this paper is to demonstrate that laparoscopy can successfully diagnose otherwise elusive Meckel's diverticuli and at the same time offer a therapeutic access for successful resection. MATERIALS AND METHODS: Two patients with anemia of unknown cause and a further patient with acute small bowel obstruction underwent diagnostic laparoscopy. A Meckel's diverticulum was identified in each case and successfully resected through a minilaparotomy. RESULTS: All three patients were successfully investigated and treated with laparoscopy with no morbidity or mortality. CONCLUSION: Laparoscopy is a safe and effective surgical modality for diagnosis of atypically presenting Meckel's diverticulum and has a therapeutic role that results in an excellent cosmetic result.     

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。     

Complications of Meckel's diverticulum.

This paper reviews the presentation and surgical pathology of 50 Meckel's diverticula encountered in one hospital in a 20-year period. It is concluded that in children with intestinal bleeding or a "raspberry tumour" of the umbilicus a Meckel's diverticulum is usually suspected. In adults with an acute surgical emergency Meckel's diverticulum is unlikely to be considered. However, a Meckel's diverticulum can give rise to surgical problems in many ways and at any age. In particular, the possiblity of an attached mesodiverticular band leading to obstruction must be stressed.     

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.     

Adult intussusception due to inverted Meckel's diverticulum: laparoscopic approach

Nowadays, laparoscopy appears to be an attractive alternative to conventional surgery in the management of small bowel obstruction. Adult intussusception is an unusual cause of intestinal obstruction, and a wide range of pathologic conditions can result with intussusception. In this report, we present a very rare case of intussusception secondary to inverted Meckel's diverticulum in an adult who underwent laparoscopic surgery. The diagnostic modalities and surgical management of intussusception are discussed.     

Laparoscopy-assisted resection of complicated Meckel's diverticulum in adults

The era of videoendoscopic surgery in emergency surgery practice has facilitated a wide range of endoscopic operative procedures. In our unit the diagnosis of acute abdomen is made after sequential clinical and laboratory examination, and diagnostic laparoscopy is advocated. Laparoscopy-assisted resection of complicated Meckel's diverticulum in two adult patients was performed, and the results are discussed. Between December 1996 and June 2000, 98 patients underwent diagnostic laparoscopy at the Cerrahpasa Medical Faculty Emergency Surgery Unit of Istanbul University because of signs and symptoms of acute abdomen. Among these, we have diagnosed one case of intestinal obstruction due to a volvulus around Meckel's diverticulum and one of acute abdomen masquerading as acute appendicitis but actually involving omphalomesenteric duct cyst torsion. Both of these patients underwent diagnostic laparoscopy and laparoscopy-assisted Meckel's diverticulectomy. Diagnostic laparoscopies were performed on 46 male (47%) and 52 female (53%) patients. In all cases, laparoscopy successfully confirmed the diagnosis. Although in 27 patients the interventions were converted to open procedures, the operations were completed laparoscopically in 71 patients. Two of these patients underwent laparoscopy-assisted Meckel's diverticulectomy and their postoperative periods were uneventful. Both patients were discharged from the hospital on their fourth postoperative day. Diagnostic laparoscopy is a safe and effective method for diagnosis of acute abdomen. In emergency surgery practices in developing countries, advanced laparoscopy should be performed to reduce expenses. Laparoscopy-assisted Meckel's diverticulectomy is a safe and economic procedure and can be performed in adults for treatment of complicated cases without staplers.     

A case of intussuscepted and incarcerated Meckel's diverticulum in to the cecum

BACKGROUND: Intussusception with the Meckel's diverticulum is rare cause of small bowel obstruction in the adults. The Meckel diverticulum is the most common cause of intestinal obstruction in children. METHODS (CASE REPORT): We present a case of 18-year-old boy with developing signs of small bowel obstruction The onset of disease was the day before the first examination. There was no hystory of prior surgery. According to the clinical symptoms, physical examinations as well as radiographic and ultrasound examination, surgical treatment was indicated. Surgical approach was inferior medial laparotomy. Intussusceptions of the Meckel's diverticulum and into the coecum with incarceration were found. Desincarceration and simple diverticulectomy was done. CONCLUSION: The Meckels's diverticulum should be consider as a possible cause of the small bowel obs-truction in previously healthy patient.     

Ileal occlusion caused by enterolith migrated from Meckel's diverticulum

The authors present a case report of an intestinal obstruction due to a relatively big coprolite migrated from a large Meckel's diverticulum to the distal Ileum. The patients apparently healthy and a vegetarian, complained on admission of the absence of emission of faeces and gas since four days before with noticeable abdominal distension. In the physical examination he presented intestinal meteorism, a hard abdomen, painful on deep palpation in the median quadrants, especially in the epigastric and mesogastric ones. The abdominal X-RAY in the standing position confirms: an occlusive state with numerous liquid levels in the Ileum. Because of a worsening of the symptomatology and the appearance of generalized comprimission, two days later an exploratory laparotomy was performed. The intervention showed the presence of a Meckel's diverticulum with approximately 10 cm in length, with an ample neck, the distal Ileum for approximately 15 cm in dilation returned rapidly to a normal calibre, after a pastous endoluminal formation borne in the Meckel's diverticulum (Meckel resection presented actually a large niche at the fundus level with a eroded wall) and migrated in the distal Ileum where it could cause the obstruction. In the present case it is probably useful to perform a preoperative CT scan in order to get a precise etiology and perform an ascending Colonscopy, so avoiding a surgical procedure. According to the authors a CT scan is indicated in all cases of intestinal occlusion of unknown case, in order to have a more precise definition of the physiopathology of the occlusion.