小儿Meckel憩室的腹腔镜治疗

作     者：Shalaby R.Y. Soliman S.M. FawyM. Samaha A. 宁亮 

作者机构：Dar Al-Shifa Hospital PO Box 3390 Safat 13034 Kuwait 

出 版 物：《世界核心医学期刊文摘（儿科学分册）》 (Dkgest of the World Latest Medical Information)

年 卷 期：2005年第1卷第8期

页      面：46-46页

学科分类：1002[医学-临床医学] 100202[医学-儿科学] 10[医学] 

主　　题：腔镜治疗 Meckel憩室 复发性腹痛 直肠出血 异位胃黏膜 阑尾切除术 结肠镜检查 术后并发症 内窥镜检查 常规化验检查 

摘      要：Background: Rectal bleeding, recurrent abdominal pain, nausea, and vomiting i n 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 wa s to evaluate the feasibility and outcome of laparoscopic management of MD. Meth ods: The clinical data of 33 children admitted with rectal bleeding and/or recur rent 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 (rang e, 3- 12 years). In 21 cases, MD was an incidental finding on laparoscopic appe ndectomy and symptomatic in 12 cases. Patients with rectal bleeding were subject ed to upper gastrointestinal endoscopy; colonoscopy, and technetium Tc 99m- lab eled 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. Upp er gastrointestinal endoscopy and colonoscopy did not show a bleeding source in 7 patients presented with bleeding per rectum. Four cases showed a positive MS u ptake. 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 ca se. Laparoscopic Meckel’s diverticulectomy and laparoscopic- assisted Meckel ’s diverticulectomy was done for 18 and 12 cases, respectively. Ectopic gastri c mucosa was present in 13 cases (44% ). Conclusions: Laparoscopy is safe, cost - effective, and efficient for the diagnosis and definitive treatment of MD. Co mpared with conventional laparotomy, it has the advantage of precise operative d iagnosis, less traumatic access, fewer intraoperative and postoperative complica tion