单孔腹腔镜技术在小儿Meckel憩室分型和治疗中的应用

目的 探讨单孔腹腔镜辅助下小儿Meckel憩室分型并指导治疗的可行性.方法 回顾性分析该院2011年8月至2015年8月收治的75例有症状Meckel憩室患儿的临床资料,均于单孔腹腔镜下对Meckel憩室分型.根据不同分型选择手术方式,术后均将切除物送病理检查.结果 75例患儿中单纯型50例,复杂型25例.单纯型、复杂型Meckel憩室患儿的平均手术时间分别为(38.93±8.75)、(55.64士13.27)min,平均术中出血量分别为(46.58±15.81)、(50.12士16.90)mL,平均术后住院时间分别为(7.33土1.41)、(7.52±1.68)d,单纯型患儿手术时间短于复杂型患儿(P＜0.05),其余指标两组比较差异均无统计学意义(P＞0.05).单纯型Meckel憩室仅见异位胃黏膜病理改变,复杂型Meckel憩室为炎性表现的比例较高,主要临床表现为下消化道出血和感染的患儿.两组患儿均获随访,随访期间1例单纯型患儿出现腹痛、便血症状,经二次手术后痊愈.结论 单孔腹腔镜辅助下可将Meckel憩室分为单纯型和复杂型,可根据不同型别选择手术方式,该方法安全可靠,值得临床推广.

Application of single port laparoscopy in classification and treatment of Meckel's diverticulum in children

Objective To explore the feasibility of single port laparoscopy in classification and treatment of Meckel's diverticulum in children and its guiding treatment.Methods The clinical data in 75 children cases of Meckel's diverticulum with symptoms treated in our hospital from Aug.2011 to Aug.2015 were retrospectively analyzed.Meckel's diverticulum was classified under single port laparoscopy.The operation modes were selected according to different classifications.The excised materials were submitted to the pathologic examination.Results Among 75 children cases,50 cases were the simple type of Meckel's diverticulum and 25 cases were complex type of Meckel's diverticulum.The average operative time in the simple type and complex type was (38.93±8.75) min and(55.64 ± 13.27) min respectively,average bleeding amounts were (46.58 ± 15.81) mL and (50.12 16.90) mL respectively,average postoperative hospitalization time was (7.33±1.41)d and (7.52 ± 1.68)d respectively,the operative time in the simple type was less than that in the complex type(P＜0.05),the other two indexes had no statistical difference between the two groups(P＞0.05).The ectopic gastric mucosal pathological change was only seen in the simple type,while the inflammatory manifestation in the complex type had higher proportion.The main clinical manifestations were lower gestational tract bleeding and infection.The two groups all obtained follow up.One case of simple type appeared the symptoms of abdominal pain and hematochezia and was cured after the second operation.Conclusion Meckel's diverticulum can be divided into the simple type and complex type under single port laparoscopy.The operation mode can be selected according to different types.This method is safe and reliable and is worthy of being clinically promoted.