小儿美克尔憩室并发消化道出血的诊治

目的:探讨小儿美克尔憩室(Meckel diverticulum,MD)合并出血的超声影像特点及手术要点。方法:回顾分析2013~2015年因消化道出血住院,经超声检查确诊为MD的14例患儿的临床资料。结果:术前14例经超声诊断MD,手术病理均与超声诊断一致,诊断符合率100%,其中12例憩室含胃黏膜上皮,2例为胰腺黏膜上皮。患儿均行经脐单孔法腹腔镜辅助手术,将憩室自脐部提出并切除。其中肠切除肠吻合6例,楔形切除8例。无中转开腹及切口感染、吻合口漏等并发症发生,无便血复发。结论:超声检查可作为可疑MD并出血的首选诊断方法。对于高度怀疑MD并出血的患儿,应常规行超声检查,操作简便,诊断准确率高。一经确诊,均应急诊手术,经脐单孔腹腔镜辅助切除美克尔憩室操作简单,切口美观,术后康复快,并发症少,疗效满意。     

腹腔镜辅助与开腹手术治疗美克尔憩室的对比研究

目的:对比分析腹腔镜辅助与开腹手术治疗美克尔憩室的手术方法与优缺点。方法:回顾分析2006年8月至2014年6月收治的101例美克尔憩室患儿的临床资料。其中56例行腹腔镜辅助手术(腔镜组),45例行开腹手术(开腹组);对比两组切口长度、手术时间、术中出血、术后排气时间、术后住院时间等指标。结果:腔镜组术中出血量、切口长度、手术时间、术后住院时间、术后排气时间明显优于开腹组(P0.05)。腔镜组术后发生肠梗阻2例,开腹组术后发生脐部感染1例。结论:腹腔镜辅助手术治疗小儿美克尔憩室具有切口小、美容、创伤小、康复快、更易被患儿家属接受等优点,可作为小儿美克尔憩室治疗的金标准。     

腹腔镜小切口辅助治疗小儿美克尔憩室45例

目的:探讨腹腔镜小切口辅助治疗小儿美克尔憩室的应用价值。方法:回顾性分析45例腹腔镜诊治美克尔憩室患儿的临床资料,总结手术步骤、小切口选择部位、手术时间、术后胃肠蠕动恢复时间及术后住院时间等数据。结果:35例行腹腔镜辅助下脐部、10例行右下腹小切口美克尔憩室切除术,45例术后均恢复良好,手术时间平均83 min(56~110min),术后平均进食时间为3.6 d(3~4 d),术后平均住院时间为7.2 d(6~9 d),术后随访无并发症。结论:腹腔镜在小儿美克尔憩室的诊治中兼具诊断和治疗的双重作用,腹腔镜辅助下小切口美克尔憩室切除术具有创伤小、痛苦小、术后恢复快、住院时间短、术后并发症低等明显优势,可作为小儿美克尔憩室治疗的首选方式。     

腹腔镜与传统手术治疗小儿美克尔憩室的对比研究

目的 回顾性分析腹腔镜手术与传统手术在治疗小儿美克尔憩室的手术效果。方法收集手术治疗的美克尔憩室伴出血28例,其中传统手术15例,腹腔镜辅助下手术13例。分析两组患儿手术时间、术后排气时间、住院时间、住院费用及并发症等差别。结果 腹腔镜辅助手术在手术时间、住院时间及术后肠功能恢复时间均较传统手术短,两者比较有统计学意义;腹腔镜手术的住院费用虽较传统术后稍高,但两者无统计学意义;传统手术术后并发症4例,腹腔镜手术术后并发症1例,两组无统计学意义。结论 腹腔镜手术由于创伤小,术后肠功能恢复快,住院时间短,切口美观等优点,是一种治疗小儿美克尔憩室的极好方法。     

腹腔镜诊治小儿小肠出血的临床价值

目的:探讨腹腔镜诊断和治疗小儿小肠出血的临床价值。方法:对消化道反复出血的40例患儿先行纤维胃镜、纤维结肠镜检及B超检查未发现阳性病变,然后用腹腔镜探查。结果:33例为美克尔憩室,4例为肠重复畸形,1例为空肠肿瘤,2例阴性。阳性患者均同时行病变肠管切除术,患者术后均恢复顺利,随访4个月-3年,1例术中未发现病变的患儿半年后再次出现便血,经保守治疗出血停止,其余患儿均未再便血。结论:腹腔镜可广泛用于诊断和治疗小儿消化道出血。     

单孔微型腹腔镜美克尔憩室楔形切除术的临床体会(附22例报告)

目的:总结单孔微型腹腔镜美克尔憩室楔形切除术的临床经验。方法:回顾分析2015年7月至2017年6月为22例患儿行腹腔镜美克尔憩室楔形切除术的临床资料。结果:21例患儿一期治愈,1例因一期手术行阑尾切除术,术后患儿出现腹痛、腹胀等肠梗阻症状,再次腹腔镜探查发现美克尔憩室,并在腹腔镜下切除。22例患儿无一例中转开腹,无肠瘘、肠梗阻、血便、肠间脓肿形成、切口疝等并发症发生,切口基本不留疤痕。手术时间40~50 min,平均(45±3)min;术中出血量3~5 ml,平均(4.0±0.7)ml;住院5~7 d,平均(6.0±0.7)d。术后随访4~12个月,平均(8±2)个月。结论:单孔微型腹腔镜美克尔憩室楔形切除术操作简单,安全可行,并发症少,对于术前腹痛诊断困难病例优势明显,值得临床推广。     

微型腹腔镜下美克尔憩室切除术临床研究

目的探讨微型腹腔镜下美克尔憩室切除术的可行性。方法 2005年2月-10月在微型腹腔镜下行小儿腹腔镜芙克尔憩室切除术13例。分别在右下腹麦氏点、脐及脐与耻骨上中点做3个3mm切口,找到憩室后用30mm 腔内吻合器切除憩室,憩室自扩大的脐部切口取出。结果 13例顺利完成手术,手术时间1．2-1．5h,出血极少,术后住院5-7d,切口疲痕不明显。结论微型腹腔镜下美克尔憩室切除术可行,创伤小,恢复快,腹壁瘢痕不明显。     

腹腔镜联合ECT诊治小儿消化道出血的临床价值

目的：探讨腹腔镜联合ECT诊断与治疗小儿消化道出血的临床价值。方法：34例患儿术前均行ECT检查,其中阳性32例,2例显示阴性且保守治疗（止血、输血等）效果欠佳,术前行胃镜、肠镜检查,排除上消化道出血及结肠病变,34例患儿均行腹腔镜探查。结果：经腹腔镜探查,28例为美克尔憩室,4例为肠重复畸形,1例为B细胞型淋巴瘤浸润回肠,1例探查阴性。ECT检查阳性32例,其中1例为消化道肿瘤,1例经腹腔镜探查结果阴性,经保守治疗未再出现便血;2例ECT检查阴性,行腹腔镜探查发现美克尔憩室。腹腔镜探查阳性的患者均同时行手术治疗,术后均恢复顺利,未见出血。结论：腹腔镜联合ECT诊治小儿消化道出血是安全、可行的,可提高小儿消化道出血的诊断率,值得广泛应用于临床。     

腹腔镜美克尔憩室切除术围术期护理

我科自2002年以来共收治美克尔憩室患儿63例,常规开腹手术17例,行腹腔镜美克尔憩室切除术46例,效果满意。现将其围手术期护理介绍如下。1临床资料1.1一般资料:本组63例,开腹组17例,男11例,女6例,年龄3个月～7岁,平均1.2岁。腹腔镜组46例,男26例,女20例,年龄3个月～6.7岁,平均1.2岁。两组均有便血史,作99mTC同位素扫描可发现下腹部有放射性的小区域[1]。1.2手术方法:两组均行全身麻醉。开腹组在右中腹直肌切口,进入腹腔行美克尔憩室切除。腹腔镜组打入适量CO2呈CO2气腹,经腹部取2个小切口进入腹腔,在镜下行美克尔憩室探查,小切口腹腔外切…     

腹腔镜辅助下小肠切除术的临床应用

资料与方法1.临床资料 :我院自 1993年 3月至 1999年 5月 ,施行腹腔镜小肠切除术 2 1例。其中男 15例 ,女 6例 ;年龄 44～ 6 8岁 ,平均 5 6 1岁。 18例患者以消化道出血就诊 ,余 3例以腹痛就诊。术前检查包括 :全消化道钡餐 2 0例次、血管造影 2例次。 2 0例患者上述检查提示小肠占位性病变 ;1例钡餐和血管造影检查均未见明显异常 ,因患者反复腹痛行腹腔镜探查 ,术中证实为美克尔憩室。术后病理学诊断 :小肠平滑肌瘤 13例、神经纤维瘤 5例、错构瘤 2例和美克尔憩室 1例。2 .手术方式 :本组 2 1例均采用插管全麻 ,行腹腔镜辅助下小肠切除术…     

针式腹腔镜用于儿童腹部手术36例报告

目的 :探讨针式腹腔镜用于治疗儿童腹部疾病的价值。方法 :回顾分析腹腔镜下行巨结肠根治术 ,美克尔憩室切除术 ,胆囊切除术 ,卵巢囊肿切除术 ,幽门肥厚切开术 ,食道裂孔疝修补术等患者的临床资料。结果 :2例中转开腹 ,余 34例顺利完成手术 ,术后患者康复。结论 :儿童腹部手术应用针式腹腔镜优点明显 ,腹腔镜在诊断腹部疑难疾病中有重要价值。随技术进步和设备改善腹腔镜手术适应证将逐步拓宽     

成人美克耳憩室49例诊治分析

目的探讨成人美克耳憩室的临床表现、诊断及治疗方法,以提高成人美克耳憩室的诊治水平。方法对我院1995年4月~2005年4月收治的成人美克耳憩室49例的临床资料进行回顾性分析。本组病人均经手术治疗。其中,行憩室切除加小肠部分切除32例,憩室切除加小肠楔形切除11例,腹腔镜辅助憩室切除加小肠部分切除6例。结果本组病例病理检查结果显示,美克耳憩室内有异位胃组织者21例,有异位胰腺组织者2例。本组病例均治愈出院。随访6月~10年,疗效满意。结论成人美克耳憩室主要表现为下消化道出血、急性憩室炎或小肠梗阻,无论有无临床症状,一经确诊,均以手术治疗为宜。腹腔镜可作为诊断和治疗成人美克耳憩室引起消化道出血的常规方法。     

Laparoscopic management of Meckel's diverticulum in children

Background

Rectal bleeding, recurrent abdominal pain, nausea, and vomiting in children could present a diagnostic as well as therapeutic challenge. Meckel's diverticulum (MD) is one of the causes. The objective of the current study was to evaluate the feasibility and outcome of laparoscopic management of MD.

Methods

The clinical data of 33 children admitted with rectal bleeding and/or recurrent abdominal pain with no identifiable cause were reviewed over a period of 8 years. There were 23 boys and 10 girls with a mean age of 5.12 ± 2 years (range, 3-12 years). In 21 cases, MD was an incidental finding on laparoscopic appendectomy and symptomatic in 12 cases. Patients with rectal bleeding were subjected to upper gastrointestinal endoscopy; colonoscopy, and technetium Tc 99m-labeled pertechnetate scan (MS). All patients were subjected to routine laboratory investigations and diagnostic laparoscopy.

Results

Of the 1200 appendectomies, incidental MD was found in 21 (1.9%) patients and symptomatic in 12 cases. Upper gastrointestinal endoscopy and colonoscopy did not show a bleeding source in 7 patients presented with bleeding per rectum. Four cases showed a positive MS uptake. Of these, 3 were found on laparoscopy to have an MD. Three cases showed a negative scan. Of these, 2 had an MD. In 5 cases with recurrent abdominal pain nausea, vomiting, and abdominal distention, diagnostic laparoscopy revealed Meckel's diverticulitis in 3 cases and intussusception secondary to MD in 1 case. Laparoscopic Meckel's diverticulectomy and laparoscopic-assisted Meckel's diverticulectomy was done for 18 and 12 cases, respectively. Ectopic gastric mucosa was present in 13 cases (44%).

Conclusions

Laparoscopy is safe, cost-effective, and efficient for the diagnosis and definitive treatment of MD. Compared with conventional laparotomy, it has the advantage of precise operative diagnosis, less traumatic access, fewer intraoperative and postoperative complications, and shorter recovery period.     

Laparoscopic-assisted resection of Meckel's diverticulum in children.

BACKGROUND AND OBJECTIVES: Meckel's diverticulum (MD) presents unique challenges for a pediatric surgeon, as it is prone to varied complications. This case series highlights the diverse presentations and laparoscopic management of MD in children. METHODS: We performed a retrospective analysis of consecutive cases of laparoscopic-assisted transumbilical Meckel's diverticulectomy (LATUM) performed by the same surgeon for incidental as well as diverse Meckel's diverticular complications over 20 months. RESULTS: Eight patients (5 males and 3 females) aged 3 years to 13 years (median, 12) underwent LATUM. Three patients had painless per-rectal bleeding and 1 presented with intestinal obstruction due to a mesodiverticular band and intestinal ischemia. Two patients had features masquerading as appendicitis; one had perforated MD with secondary inflammation of the appendix, and the other had a torsed, gangrenous MD. In 2 patients, incidental MD with a narrow base was noted at appendicectomy for appendicitis. All patients underwent successful LATUM along with appendicectomy in 4 patients. The operative duration was 72 minutes to 165 minutes (mean, 112.1+/-30.6). There were no operative complications, and no conversion to open surgery was required. The hospital stay was 4 days to 7 days (mean, 4.7+/-1.2). The patient with mesodiverticular band intestinal obstruction presented with adhesive intestinal obstruction 2 weeks after the surgery. Laparoscopic-assisted minilaparotomy was done to release the pelvic adhesions. There were no other complications during the follow-up (median, 11 months). CONCLUSIONS: LATUM is a simple, safe, and effective procedure with a better cosmetic outcome that can be performed for diverse manifestations of MD. The technique also allows palpation of the MD and avoids use of expensive staplers.     

National trends in the surgical management of Meckel's diverticulum

Background

Treatment recommendations for Meckel's diverticulum (MD) come mostly from single-institution case series. The objective of this study was to review the surgical management and outcomes of children undergoing Meckel's diverticulectomy using contemporary data from a national database.

Methods

We queried 2007 to 2008 data from the Pediatric Health Information System database and analyzed demographic and outcome variables for patients undergoing surgical resection of MD. Cases were classified as primary (symptomatic MD) or secondary (incidental MD). Outcomes in primary cases were compared between open and laparoscopic approaches. Statistical analyses were performed using SPSS (Chicago, IL).

Results

Eight hundred fifteen children underwent Meckel's diverticulectomy. Meckel's diverticulectomy was more common in boys (boy-girl, 2.3:1), and half (53%) of the children required surgery before their fourth birthday. More cases (n = 485; 60%) were classified as primary, and most children were approached by laparotomy (75%). The most common presentations for primary cases were obstruction (30%), bleeding (27%), and intussusception (19%). In the primary group, patients treated with the laparoscopic approach had a shorter length of stay (open approach, 5.7 ± 5.2 days; laparoscopic approach, 4.3 ± 2.7 days; P < .02).

Conclusion

These data describe current trends in the surgical treatment of MD in the United States. Laparoscopic Meckel's diverticulectomy appears to shorten length of stay but is used much less frequently than the traditional open approach.     

Meckel's diverticulum: ten years experience

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. The majority of MD cases are asymptomatic although they can, occasionally, cause complications such as bleeding, intestinal obstruction and/or inflammatory process. The diagnosis is difficult and it is usually made at surgery. The treatment of choice in the patients with symptomatic MD is surgical resection while difference of opinion there are about the treatment of asymptomatic MD. The present study concerns 9 cases of MD, 7 symptomatic and 2 incidentally found during surgical abdominal operations. Six patients was males and 3 females with 2:1 male: female ratio. The mean age was 14.7 years. The most common complication was the diverticulitis with the perforation of MD in 1 patient. All patients, symptomatic and asymptomatic, was operated. The diverticulectomy was made in 7 patients while in 2 cases we had to perform an intestinal resection. There was not operative mortality, while there were 2 cases of postoperative complications which occurred only in the patients with symptomatic MD. The Authors believe that there is no factor predictive of the development of diverticular complications. They recommend, in light of the low postoperative mortality and morbidity, the surgical treatment also in the cases of asymptomatic MD, in the absence of absolute contraindications.     

腹腔镜诊治儿童美克尔憩室出血

目的研究腹腔镜在儿童Meckel憩室出血诊断和治疗中的应用。方法分析近年来采用腹腔镜治疗的Meckel憩室出血病例31例,男19例,女12例。结果腹腔镜治疗31例Meckel憩室中1例因粘连广泛改行开腹手术,合并肠重复畸形1例,肠套叠2例。其中楔形切除吻合12例,肠切除端-端吻合18例。同时进行了3例阑尾及4例斜疝的联合手术。结论腹腔镜的应用为儿童Meckel憩室出血的诊断和治疗提供了一条极好的途径,具有诊断和治疗的双重作用。提高了疾病的诊断率,减少了并发症的发生率,降低了医疗费用。     

腹腔镜在腹部外伤治疗中的应用

目的:分析应用腹腔镜经原创口诊断与治疗腹部外伤的临床价值。方法:2003年7月至2006年12月,对具有剖腹探查指征的14例腹部外伤患者使用腹腔镜经原创口诊断,并根据镜检结果决定镜下治疗或中转开腹手术。结果:14例腹部外伤患者均于镜下作出正确诊断,5例镜下手术,2例可免治疗性处理;7例中转开腹手术,其中5例于腹腔镜辅助下手术,全组均治愈出院。结论:腹腔镜诊治腹部外伤具有创伤小、安全可靠、诊断率高,并有效降低阴性剖腹探查率等优点,适用于大部分腹部外伤的病例。     

Laparoscopic management of symptomatic Meckel's diverticula: a simple tangential stapler excision.

BACKGROUND: Meckel's diverticulum was first described about 400 years ago and continues to be a rare congenital disorder. Laparoscopic surgery for Meckel's diverticulum has been described in mostly case reports. We present our series of patients with symptomatic Meckel's diverticulum. METHODS: We have treated 12 patients with symptomatic Meckel's diverticulum from 1994 through 2006 at our institution. All the patients presented with features of either appendicitis or peritonitis, some with a vague abdominal mass. Clinical diagnosis of Meckel's diverticulum was made in only 4 patients. Diagnostic laparoscopy confirmed Meckel's diverticulitis in all patients. Laparoscopic stapler resection of the lesions was performed for all patients, tangential excision in 10 and wedge excision in 2. RESULTS: The incidence of Meckel's diverticulum at our institution is 0.3%. The majority of patients were male children. There were no staple-line leaks in any case. All patients recovered well postoperatively, and the day of discharge was in the range of the fourth to the seventh POD. Heterotopic gastric mucosa was found in the majority of the diverticula. Eight patients were followed up for 24 months, and 4 patients reported for follow-up after 45 months and were found to be symptom-free. DISCUSSION: The diagnosis of Meckel's diverticulitis is rarely made preoperatively. Surgical resection is indicated only if the diverticulum is symptomatic or if the base is narrow. Traditionally, open wedge resection (including the anterior wall of the ileum) of the diverticulum is the treatment. We think that a simple tangential stapler resection can also be performed, with good outcome. CONCLUSION: Laparoscopy is useful in both diagnosis and treatment. Laparoscopic resection of Meckel's diverticulum is feasible and ideal, especially when performed in specialized centers.