成人美克尔憩室致肠梗阻的诊治

目的总结成人美克尔憩室致肠梗阻的外科诊治特点。方法对11例成人美克尔憩室致肠梗阻的病例进行回顾性分析。所有病例均表现为无明确诱因的急性肠梗阻,其中9例为完全性梗阻(5例发生绞窄),2例为不完全性梗阻。临床特点是起病急、进展快、易出现肠绞窄。内疝是形成梗阻的主要原因。结果全组11例均经手术探查证实诊断并进行治疗,憩室直径平均1.8(1.2~2.3)cm,长度平均5.1(3.5~7.0)cm。2例行憩室单纯切除,9例行小肠部分切除术,全部治愈。结论美克尔憩室致肠梗阻为外科急症,进展迅速且非手术治疗效果不佳。凡无明确诱因的成人(尤其是青壮年)急性肠梗阻均应考虑到本病,并应积极剖腹探查。术前无需进行过多的特殊检查。详尽的病史资料对诊断很有帮助,CT扫描有助于鉴别回盲部肿瘤所致肠梗阻。

Diagnosis and Treatment of Intestinal Obstruction Secondary to Meckel's Diverticulum in Adults

Objective To iovestigate diagnosis and treatment of intestinal obstruction secondary to Meckel's diverticulum in adults. Method 11 cases of intestinal obstruction secondary to Meckel's diverticulum in adults were retrospectively reviewed. All cases presented acute intestinal obstruction with unknown cause, including complete obstruction in 9 cases (5 cases developed strangulation). The clinical manifestation can be characterized by acute onset, rapid progress and high likehood to develop strangulation. The mechanism of the obstruction is internal hernia. Result All cases underwent surgery, and the diverticulum was 1.8 cm in diameter in average and 5.1 cm in length in average. 2 cases were underwent resection of diverticulum and the rest 9 cases underwent partial excision of small intestinal. Conclusion The Meckel's diverticular related intestinal obstruction should be considered in the case of acute intestinal obstruction with unknown cause in auldts, and laparotomy could be recommendable.