發(fā)布時(shí)間：2018-04-26 08:28

  本文選題：兒童 + 梅克爾憩室��； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的總結(jié)兒童梅克爾憩室(MD)并發(fā)癥的臨床特點(diǎn)及診治要點(diǎn),為臨床合理治療提供參考。方法回顧性分析98例兒童MD并發(fā)癥的臨床特點(diǎn)、輔助檢查結(jié)果及治療情況,總結(jié)MD并發(fā)癥的臨床特點(diǎn)及診治要點(diǎn)。結(jié)果(1)本組因MD并發(fā)癥住院治療患兒98例,男性76例,女性22例,男女比例約為3.5∶1,并發(fā)癥包括MD引起的便血、腸梗阻、腹腔炎癥等,其中以便血最常見(58/98=59.18%)。(2)本組51例MD術(shù)前行~(99)TcmO_4~-ECT檢查,其中43例提示異位胃粘膜可能,檢出率為84.31%;84例術(shù)前行腹部超聲檢查,其中37例考慮MD可能,檢出率為44.05%,經(jīng)卡方檢驗(yàn),放射性核素與腹部超聲對(duì)MD患者檢出率有統(tǒng)計(jì)學(xué)差異(P=0.02,P0.05)。(3)58例以便血為主要表現(xiàn)患兒中,其中42例術(shù)前同時(shí)行了放射性核素檢查和超聲檢查,陽性發(fā)現(xiàn)率分別為80.95%和66.67%。經(jīng)卡方檢驗(yàn),放射性核素與超聲對(duì)MD伴便血患兒檢出率無統(tǒng)計(jì)學(xué)差異(P=0.14,P0.05)。(4)本組因MD致腸梗阻的26例患兒中,有24例術(shù)前行腹部超聲檢查,其中10例考慮腸套疊,10例考慮腸梗阻可能,檢出率為83.33%。14例梅克爾憩室炎癥病例中,有12例術(shù)前行腹部超聲檢查,其中8例考慮急性闌尾炎或MD可能,檢出率為66.67%。(5)98例患兒均通過手術(shù)治療治愈,其中75例行剖腹探查術(shù),另外23例通過腹腔鏡輔助治療;憩室距回盲部平均距離為48.7±17.1厘米,術(shù)后未發(fā)生各種并發(fā)癥。結(jié)論梅克爾憩室臨床表現(xiàn)多樣且缺乏特異性,以便血最多,超聲在診斷梅克爾憩室伴便血中有較高的特異性,聯(lián)合放射性核素檢查可提高檢出率;對(duì)于梅克爾憩室伴炎癥及腸梗阻的患兒,腹部超聲對(duì)其各種并發(fā)癥的檢出及判斷具有較高的診斷符合率,有利于減少急腹癥的誤診,但術(shù)前確診MD比較困難。
[Abstract]:Objective to summarize the clinical features, diagnosis and treatment of MDD complications in children with Meckel's diverticulum. Methods the clinical features, auxiliary examination results and treatment of 98 children with MD complications were retrospectively analyzed, and the clinical features, diagnosis and treatment of MD complications were summarized. Results (1) 98 cases (76 males and 22 females) were hospitalized for MD complications. The ratio of male to female was about 3.5: 1. The complications included hematochezia, intestinal obstruction, abdominal inflammation and so on. In this group, 51 cases of MD were examined before MD. 43 of them indicated the possibility of ectopic gastric mucosa, the detection rate was 84.31 and 84 cases underwent abdominal ultrasonography before operation. 37 cases considered MD possibility, the detection rate was 44.05 and the rate was chi-square test. There was statistical difference between radionuclide and abdominal ultrasound in the detection rate of MD patients. Among the 58 cases of MD, 42 of them underwent radionuclide examination and ultrasound examination simultaneously before operation. The positive detection rates were 80.95% and 66.67% respectively. By chi-square test, there was no statistical difference between radionuclide and ultrasound in the detection rate of hematochezia in children with MD. Among the 26 cases of intestinal obstruction caused by MD, 24 cases were examined by abdominal ultrasound before operation. Among them, 10 cases considered intussusception and 10 cases considered the possibility of intestinal obstruction. The detection rate was 83.33.14 cases of inflammation of Meckel's diverticulum, 12 cases underwent abdominal ultrasound examination before operation, 8 cases considered acute appendicitis or MD possibility. The detection rate was 66.67 and 50.98 cases were cured by surgical treatment, 75 cases underwent laparotomy and 23 cases were treated with laparoscopy, the average distance from the ileocecal part of diverticulum was 48.7 鹵17.1 cm, and there were no complications after operation. Conclusion the clinical manifestations of Meckel's diverticulum are various and lack of specificity, so that the blood is the most. Ultrasound has a high specificity in diagnosing Mekel's diverticulum with hematochezia. Combined radionuclide examination can improve the detectable rate of Meckel's diverticulum. For children with Meckel's diverticulum accompanied by inflammation and intestinal obstruction, abdominal ultrasound has a high diagnostic coincidence rate for the detection and judgement of various complications, which is helpful to reduce the misdiagnosis of acute abdomen, but it is difficult to diagnose MD before operation.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.5

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