儿童梅克尔憩室并发症的临床分析

发布时间：2018-04-26 08:28

本文选题：儿童 + 梅克尔憩室　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的总结儿童梅克尔憩室(MD)并发症的临床特点及诊治要点,为临床合理治疗提供参考。方法回顾性分析98例儿童MD并发症的临床特点、辅助检查结果及治疗情况,总结MD并发症的临床特点及诊治要点。结果(1)本组因MD并发症住院治疗患儿98例,男性76例,女性22例,男女比例约为3.5∶1,并发症包括MD引起的便血、肠梗阻、腹腔炎症等,其中以便血最常见(58/98=59.18%)。(2)本组51例MD术前行~(99)TcmO_4~-ECT检查,其中43例提示异位胃粘膜可能,检出率为84.31%;84例术前行腹部超声检查,其中37例考虑MD可能,检出率为44.05%,经卡方检验,放射性核素与腹部超声对MD患者检出率有统计学差异(P=0.02,P0.05)。(3)58例以便血为主要表现患儿中,其中42例术前同时行了放射性核素检查和超声检查,阳性发现率分别为80.95%和66.67%。经卡方检验,放射性核素与超声对MD伴便血患儿检出率无统计学差异(P=0.14,P0.05)。(4)本组因MD致肠梗阻的26例患儿中,有24例术前行腹部超声检查,其中10例考虑肠套叠,10例考虑肠梗阻可能,检出率为83.33%。14例梅克尔憩室炎症病例中,有12例术前行腹部超声检查,其中8例考虑急性阑尾炎或MD可能,检出率为66.67%。(5)98例患儿均通过手术治疗治愈,其中75例行剖腹探查术,另外23例通过腹腔镜辅助治疗;憩室距回盲部平均距离为48.7±17.1厘米,术后未发生各种并发症。结论梅克尔憩室临床表现多样且缺乏特异性,以便血最多,超声在诊断梅克尔憩室伴便血中有较高的特异性,联合放射性核素检查可提高检出率;对于梅克尔憩室伴炎症及肠梗阻的患儿,腹部超声对其各种并发症的检出及判断具有较高的诊断符合率,有利于减少急腹症的误诊,但术前确诊MD比较困难。
[Abstract]:Objective to summarize the clinical features, diagnosis and treatment of MDD complications in children with Meckel's diverticulum. Methods the clinical features, auxiliary examination results and treatment of 98 children with MD complications were retrospectively analyzed, and the clinical features, diagnosis and treatment of MD complications were summarized. Results (1) 98 cases (76 males and 22 females) were hospitalized for MD complications. The ratio of male to female was about 3.5: 1. The complications included hematochezia, intestinal obstruction, abdominal inflammation and so on. In this group, 51 cases of MD were examined before MD. 43 of them indicated the possibility of ectopic gastric mucosa, the detection rate was 84.31 and 84 cases underwent abdominal ultrasonography before operation. 37 cases considered MD possibility, the detection rate was 44.05 and the rate was chi-square test. There was statistical difference between radionuclide and abdominal ultrasound in the detection rate of MD patients. Among the 58 cases of MD, 42 of them underwent radionuclide examination and ultrasound examination simultaneously before operation. The positive detection rates were 80.95% and 66.67% respectively. By chi-square test, there was no statistical difference between radionuclide and ultrasound in the detection rate of hematochezia in children with MD. Among the 26 cases of intestinal obstruction caused by MD, 24 cases were examined by abdominal ultrasound before operation. Among them, 10 cases considered intussusception and 10 cases considered the possibility of intestinal obstruction. The detection rate was 83.33.14 cases of inflammation of Meckel's diverticulum, 12 cases underwent abdominal ultrasound examination before operation, 8 cases considered acute appendicitis or MD possibility. The detection rate was 66.67 and 50.98 cases were cured by surgical treatment, 75 cases underwent laparotomy and 23 cases were treated with laparoscopy, the average distance from the ileocecal part of diverticulum was 48.7 卤17.1 cm, and there were no complications after operation. Conclusion the clinical manifestations of Meckel's diverticulum are various and lack of specificity, so that the blood is the most. Ultrasound has a high specificity in diagnosing Mekel's diverticulum with hematochezia. Combined radionuclide examination can improve the detectable rate of Meckel's diverticulum. For children with Meckel's diverticulum accompanied by inflammation and intestinal obstruction, abdominal ultrasound has a high diagnostic coincidence rate for the detection and judgement of various complications, which is helpful to reduce the misdiagnosis of acute abdomen, but it is difficult to diagnose MD before operation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.5

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