上海交通大学学报(医学版) ›› 2020, Vol. 40 ›› Issue (2): 242-.doi: 10.3969/j.issn.1674-8115.2020.02.016

• 论著·临床研究 • 上一篇    下一篇

成人梅克尔憩室并发症的诊断和手术治疗

曾令鹏,张 庆,关晏星,刘少正,陈庆杰,张 青   

  1. 南昌大学第一附属医院核医学科,南昌 330006
  • 出版日期:2020-02-28 发布日期:2020-03-20
  • 通讯作者: 张 青,电子信箱:hhh3357@sina.com。
  • 作者简介:曾令鹏(1989—),男,住院医师,硕士;电子信箱:zlphyx@163.com。

Diagnosis and surgical treatment of adult Merkel diverticulum with complications

ZENG Ling-peng, ZHANG Qing, GUAN Yan-xing, LIU Shao-zheng, CHEN Qing-jie, ZHANG Qing   

  1. Department of Nuclear Medicine, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
  • Online:2020-02-28 Published:2020-03-20

摘要: 目的·分析成人梅克尔憩室(Meckel diverticulum,MD)并发症的临床特征、诊断与治疗方法。方法·回顾性分析2009—2019年南昌大学第一附属医院收治的39例成人MD并发症患者的临床基本资料、99mTcO4-异位胃黏膜核素显像、腹部CT、治疗方法等资料,分析不同并发症患者在年龄、性别、临床特征等之间的差异。结果·成人MD男女发病率之比为3.88:1;症状以无痛性血便、腹痛、恶心呕吐等常见;并发症以出血、憩室炎、肠梗阻为主,分别占53.8%、25.6%和20.5%。不同并发症患者之间临床特征比较,发生出血、憩室炎、肠梗阻患者在性别、年龄之间的差异无统计学意义,而憩室与回盲部的距离在3组患者之间比较,差异有统计学意义(P0.010),且出血组憩室与回盲部的距离大于肠梗阻组(P0.040)。19例患者进行了核素显像检查,阳性检出率为63.2%(12/19),均为出血患者。39例患者经腹部CT检查,MD检出率为15.4%(6/39),均为憩室炎患者;而在憩室炎患者中,CT检查的检出率为60.0%(6/10)。所有患者均行手术切除治疗。结论·成人MD并发症的发生率较低,以男性发病为主;并发症以便血最为常见,便血患者憩室与回盲部的距离远于肠梗阻患者;99mTcO4-核素显像对MD并发便血诊断有重要意义,腹部CT对憩室炎诊断价值较高,必要时联合检查可提高检出率;对成人MD并发症患者均可采用手术治疗。

关键词: 成人, 梅克尔憩室, 并发症, 诊断, 治疗

Abstract: Objective · To analyze the clinical features, diagnosis and treatment of adult Merkel diverticulum (MD) with complications. Methods · The basic clinical data, 99mTcO4- ectopic gastric mucosal radionuclide imaging, abdominal CT and treatment methods of 39 patients with MD complications in the First Affiliated Hospital of Nanchang University 2009 to 2019 were analyzed retrospectively. The differences of age, gender and clinical characteristics among the patients with different complications were analyzed. Results · The incidence rate of male MD and female MD was 3.88:1; the symptoms were painless bloody stool, abdominal pain, nausea and vomiting, etc. The main complications were hemorrhage, diverticulitis and intestinal obstruction, accounting for 53.8%, 25.6% and 20.5%, respectively. The gender and age among the patients with complications of hemorrhage, diverticulitis and intestinal obstruction were not statistically different, while the distance between diverticulum and ileocecal was statistically significant among the three groups (P0.010). The distance between diverticulum and ileocecal in the hemorrhage group was farther than that in the intestinal obstruction group (P0.040). Nineteen patients underwent radionuclide imaging examination, the positive detection rate was 63.2% (12/19), and 12 cases were bleeding patients. Thirty-nine cases were examinedabdominal CT, and the overall detection rate was 15.4% (6/39). All the 10 patients were diverticulitis, in with the detection rate of CT examination was 60.0% (6/10). All patients underwent surgical resection. Conclusion · The incidence of MD complications in adults is low, mainly in males. The most common complication is hemorrhage, and the distance between diverticulum and ileocecal of hemorrhage patients is farther than that of intestinal obstructive patients. 99mTcO4- radionuclide imaging is important for the diagnosis of MD complicated with blood in the stool, and the abdominal CT has a high diagnostic value for diverticulitis. If necessary, combined examination can improve the detection rate. MD complications in adults can be treatedsurgery.

Key words: adult, Meckel diverticulum (MD), complication, diagnosis, treatment