腹腔镜下利用套扎器治疗小儿梅克尔憩室

Laparoscopic Treatment with Ligation Device of Meckel’s Diverticulum in Children

摘要: 目的：探讨腹腔镜下利用套扎器治疗小儿梅克尔憩室的临床疗效和可行性。方法：收集2017年12月至2019年4月于我科治疗的梅克尔憩室患儿临床资料，选择憩室基底部直径 ≤ 1.0 cm、HDR ≥ 2.0的10例患儿行腹腔镜下利用套扎器治疗梅克尔憩室。收集手术时间、术中出血、术后恢复情况、组织病理等数据及随访资料等。结果：本组10例均在腹腔镜下顺利完成梅克尔憩室切除，手术时间25~60 min，平均(36.21 ± 12.30) min，术中出血量2~10 ml，平均出血量为4 ml。8例术后病理检测出HGM，其中6例HGM仅分布于憩室顶端，2例分布于顶端并延伸至憩室体部；1例于顶端检测到散在异位胰腺组织，1例未检测到HGM，切缘均未累及。10例患儿术后1~2.5 d胃肠蠕动恢复，2~3 d给予流质饮食，术后3~6 d出院，术后平均住院4.5 d。随访12~24个月，患儿手术效果满意，无便血、腹痛、粘连性肠梗阻等并发症。结论：对于基底部直径 ≤ 1.0 cm、HDR ≥ 2.0的指状憩室，腹腔镜下利用套扎器结扎憩室根部切除，手术安全有效，且有创伤小，恢复快，并发症少，美容满意等优点，具有一定临床推广价值。

Abstract: Objective: To assess the clinical efficacy and feasibility of laparoscopic treatment with ligation device of Meckel's diverticulum in children. Methods: Clinical data of 10 laparoscopic Meckel's diverticulectomy were analyzed, whose base diameter was ≤1.0 cm and HDR ≥ 2.0. Results: All of the diverticula were resected successfully using ligator. The operative time was 25 to 60 min, with an average of (36.21 ± 12.30) min, and the mean blood loss was 4 ml. HGM was detected pathologically in 8 cases, of which 6 cases were only distributed on the tip of the diverticulum, and 2 cases were distributed on the tip and extended to the body part of the diverticulum. Scattered heterotopic pancreatic tissue was detected at the apex in 1 case, and 1 case without HGM. Ten patients recovered from gastrointestinal motility from 1 to 2.5 days after operation, and were given a liquid diet from 2 to 3 days. They were discharged from 3 to 6 days after operation, and the average postoperative hospitalization was 4.5 days. All children were followed up for 12 to 24 months. The results were satisfactory, and there were no complications such as hematochezia, abdominal pain and adhesive ileus. Conclusion: For finger-shaped diverticulum whose basal diameter is less than 1.0 cm and HDR ≥ 2.0, laparoscopic removal of diverticulum by a ligator is safe and effective. And it has the advantages of less trauma, faster recovery, fewer complications and aesthetic satisfaction, which has certain clinical promotion value.