摘要
目的回顾性分析了梅克尔憩室并消化道出血患儿的临床和病理特征,以提高诊治水平。方法 收集2015年1月至2017年12月因消化道出血在我院住院患儿,经手术确诊为梅克尔憩室并出血患儿60例为研究对象,分析其临床特点、辅助检查和病理结果。结果 (1)60例梅克尔憩室并出血患儿,男49例,女11例,男女比例为4.45∶1。(2)均伴有不同程度的贫血,以中重度贫血最常见(49/60,81.7%)。(3)60例患儿伴随症状分别为腹痛17例(28.3%),呕吐11例(18.3%),发热2例(3.3%),无伴随症状38例(63.3%)。(4)56例行放射性核素锝-99m扫描,54例阳性(96.4%),2例阴性(3.6%)。(5)病理结果中有59例(98.3%)见异位胃黏膜,1例(1.7%)见异位胃黏膜及胰腺组织。(6)超声发现梅克尔憩室的阳性率显著低于放射性核素锝-99m扫描,差异有统计学意义(P<0.05)。(7)60例均行回肠部分切除,术中发现憩室位于距离回盲部约10~80cm,平均(46.3±15.7)cm;憩室长2~6cm。结论 小儿梅克尔憩室并出血术前诊断困难,缺乏特异性临床症状和体征,病情进展迅速,放射性核素锝-99m扫描敏感度高,一旦确诊,外科手术切除是主要治疗方法。
Objective To evaluate the clinical and pathologic charateristics of children with bleeding and Meckel's diverticulum,so as to improve the level of diagnosis and treatment. Methods The clinical data of 60 patients diagnosed with bleeding and Meckel's diverticulum who were admitted to our hospital from January 2015 to December 2017 were collected. The diagnosis was confirmed by surgery and pathology. Clinical characteristics, auxiliary examinations and pathological results were analyzed. Results (1) In total, 60 children were diagnosed with bleeding MD. Of these,49 were male and 11 were female, with a male to female ratio of 4.45∶1.(2)There are many different degree of anemia, with 49(81.7%) to be moderate or severe anemia.(3)The associated symptoms were different among the patients:17(28.3%) patients had abdominal pain, 11(18.3%) had vomiting, 2(3.3%) had fever, and 38(63.3%) had no associated symptoms.(4)Totally 56 patients were examined by technetium-99m pertechnetate imaging. Among these patients, 54(96.4%) had positive results,2(3.6%) had negative results.(5)The postoperative histology revealed that ectopic gastric mucosa existed in 59 patients(98.3%), and both gastric and pancreatic ectopic tissue in 1 patient(1.7%).(6)The positive detection rate was significantly lower by ultrasonography than by technetium-99m pertechnetate scan( P <0.05).(7)All the 60 patients underwent partial ileal resection. In the surgery, it was found that the distance from the diverticulum to the ileocecal valve was 10 to 80 cm (average 46.3±15.7 cm). Diverticulum length ranged from 2.0 to 6.0 cm. Conclusion Preoperative diagnosis of bleeding and Meckel diverticulum is difficult. Meckel diverticulum patients with bleeding usually lack specific clinical symptoms and typical signs. The disease develops fast. Technetium-99m pertechnetate imaging may give higher diagnostic rate of bleeding and Meckel's diverticulum. Surgical resection is necessary once a diagnosis of bleeding MD is made.
作者
朱忠生
周少明
王朝霞
ZHU Zhongsheng;ZHOU Shaoming;WANG Zhaoxia(Shenzhen Children's Hospital, Shenzhen 518026,China)
出处
《中国中西医结合儿科学》
2019年第3期222-225,共4页
Chinese Pediatrics of Integrated Traditional and Western Medicine
关键词
梅克尔憩室
出血
放射性核素锝-99m
儿童
Meckel's diverticulum
Bleeding
Technetium-99m pertechnetate
Children
