经肛气囊辅助小肠镜对成人Meckel憩室术前诊断的价值

Retrograde balloon assisted enteroscopy has advantages in preoperative diagnosis of adult Meckel’s diverticulum

摘要:

【摘要】 目的 分析总结Meckel憩室的临床特点,明确经肛气囊辅助小肠镜对Meckel憩室的诊断价值。方法 回顾性分析2015.01.01至2018.01.01期间于我院诊断及治疗的Meckel憩室患者的病例资料,统计分析所有患者的一般资料、临床表现、诊断方法、治疗经过及病理结果等信息,对同时完善经肛气囊辅助小肠镜检查及外科手术治疗的患者,配对比较两种方法对Meckel憩室位置的评估差异。结果 37例成人Meckel憩室患者的平均年龄为(32.35±15.25)岁,男女比例为3.6：1,主要症状包括便血(28/37),黑便(5/37),腹痛(4/37)。经肛小肠镜检查之前,20例患者行腹部CT检查,13例行胶囊内镜检查,7例行经口小肠镜检查,6例行全消化道造影检查,5例行血管造影检查,均未发现Meckel憩室。37例患者中1例因出血性休克直接行开腹手术治疗,其余36例均行经肛小肠镜检查并明确术前诊断后行外科手术治疗,经肛小肠镜下及外科手术中评估Meckel憩室距离回盲瓣的距离分别为(94.03±18.93)cm,(92.08±23.83)cm,二者差异无统计学意义(P>0.05)。术后病理结果显示37例憩室的长度平均为(5.66±2.16)cm,其中憩室中合并胃黏膜异位者8例,胰腺异位1例,1例合并粘液腺癌。结论 成人Meckel憩室主要以便血为主的消化道出血症状就诊,经肛气囊辅助小肠镜对成人Meckel憩室的术前定性及定位诊断都具有极高的价值。

Abstract:

[Abstract] Objective To analyze the advantages of retrograde balloon assisted enteroscopy in preoperative diagnosis of adult Meckel’s diverticulum. Methods All the data of patients diagnosed as Meckel’s diverticulum in our hospital between January 01, 2015 to January 01, 2018 were retrospectively analyzed, and a paired sample test was carried out for these who underwent both retrograde balloon assisted enteroscopy and surgical treatment. Results 37 patients were admitted, 29 of them were male, the average age was (32.35±15.25)years. Main presentations were hematochezia (28/37)、melena (5/37) and abdominal pain (4/37). Before the surgical treatment, 20 underwent abdominal CT scan, 13 underwent capsule endoscopy, 7 underwent anterograde enteroscopy, 6 had gastrointestinal barium meal examination and 5 had selective celiac arteriography, none of these diagnostic examinations found the Meckel’s diverticulum until the retrograde enteroscopy. The average distance between Meckel’s diverticulum and ileocecal valve was (94.03±18.93)cm in enteroscopic estimation and (92.08±23.83)cm in intraoperative estimation, the difference has no statistical significance (P>0.05). Postoperative pathological study found the average length of Meckel’s diverticulum was (5.66±2.16)cm, and 8 of the specimens have ectopic gastric mucosa, 1 have ectopic pancreas, 1 of the Meckel’s diverticulum combined with mucinous adenocarcinoma. Conclusions Adult Meckel’s diverticulum complications mainly present as gastrointestinal bleeding, retrograde balloon assisted enteroscopy have great advantages in preoperative diagnosis of this malformation.