超声在诊断小儿梅克尔憩室所致肠梗阻中的临床价值

doi:10.20223/j.cnki.1000-8535.2024.12.009

摘要/Abstract

摘要： 目的探讨高频超声对小儿梅克尔憩室所致肠梗阻的诊断价值。方法选取广州市妇女儿童医疗中心2018年1月—2023年12月经手术证实的由梅克尔憩室引起的肠梗阻患儿41例作为研究对象,回顾性分析患儿临床资料及超声表现,并与术中所见和病理结果进行对照。结果 41例患儿,发病平均年龄为（3.97±3.69）岁,其中男32例、女9例。术前超声诊断肠梗阻38例,诊断符合率为92.7%;诊断梅克尔憩室所致肠梗阻9例,诊断符合率为21.9%。术中诊断梅克尔憩室索带卡压肠管24例,腹内疝8例,肠扭转1例;肠套叠10例;梅克尔憩室炎症、粘连6例,粘连穿孔1例;憩室内异物并穿孔1例。结论高频超声对小儿肠梗阻有重要的诊断价值,仔细探查可以明显提高梅克尔憩室所致肠梗阻的临床诊断率,为临床尽早手术提供重要依据。

关键词: 超声, 梅克尔憩室, 肠梗阻, 小儿

Abstract: Objective To investigate the diagnostic value of high frequency ultrasound for intestinal obstruction caused by Meckel's diverticulum in children．Methods From January 2018 to December 2023,41 children with intestinal obstruction caused by Meckel's diverticulum were selected as the study objects．The clinical data and ultrasound images of the children were analyzed retrospectively,and compared with the intraoperative and pathological results．Results In 41 patients,the average age of onset was（3.97±3.69）years ,including 32 males and 9 females．Preoperative ultrasonic diagnosis of intestinal obstruction in 38 cases,diagnosis coincidence rate was 92.7%．Intestinal obstruction caused by Meckel's diverticulum was diagnosed in 9 cases,the diagnosis coincidence rate was 21.9%．During the operation,24 cases of Meckel's diverticulum intestinal compression were diagnosed,8 cases of abdominal hernia,1 case of intestinal torsion,and intussusception of 10 cases．Meckel's diverticulum had inflammation and adhesion in 6 cases and adhesion perforation in 1 case．A case of foreign body in diverticulum with perforation．Conclusions High-frequency ultrasound has an important diagnostic value for intestinal obstruction in children．Careful exploration can significantly improve the clinical diagnosis rate of intestinal obstruction caused by Meckel's diverticulum,and provide an important basis for early clinical operation．

Key words: ultrasound, Meckel's diverticulum, intestinal obstruction, pediatric patient

杜妍妍, 陈辉, 李晓菲, 李秦莉. 超声在诊断小儿梅克尔憩室所致肠梗阻中的临床价值[J]. 广州医药, 2024, 55(12): 1444-1449.

DU Yanyan, CHEN Hui, LI Xiaofei, LI Qinli. Clinical value of ultrasound in the diagnosis of intestinal obstruction caused by pediatric Meckel's diverticulum[J]. Guangzhou Medical Journal, 2024, 55(12): 1444-1449.

参考文献

[1] MCKELVIE M,SOARES-OLIVEIRA M,WANG-KOH Y,et al.Beware the innocent presentation of a spontaneous perforated meckel diverticulum:A rare case and review of the literature[J].Pediatr Emerg Care, 2019,35(12):881-883.
[2] YAN L,ZHOU B,WU P,et al.Meckel's diverticulum mimicking acute appendicitis in children:A retrospective cohort study[J].BMC Surg,2024,24(1):40.
[3] MACHADO C,PÉREZ J,BOLÍVAR A M G,et al.Meckel's diverticulitis,an uncommon cause of acute abdomen[J].Medicina,2023,83(4):631-634.
[4] BLEVRAKIS E,PARTALIS N,SEREMETI C,et al.Meckel's diverticulum in paediatric practice on Crete(Greece):A 10-year review[J]. Afr J Paediatr Surg,2011,8(3):279-282.
[5] LI L,ZHAN X,CHEN Y,et al.Application of small bowel capsule endoscopy in children with Meckel's diverticulum[J].Eur J Gastroenterol Hepatol,2024,36(7):845-849.
[6] FARRELL M B,ZIMMERMAN J.Meckel's diverticulum imaging[J].J Nucl Med Technol,2020,48(3):210-213.
[7] SUN Y M,XIN W,LIU Y F,et al.Appendicitis combined with Meckel's diverticulum obstruction,perforation,and inflammation in children:Three case reports[J].World J Clin Cases,2024,12(4):865-871.
[8] KOCAMAN O H,GNEND T .Different clinical symptoms and surgical treatment of Meckel's diverticulum in children[J].Dicle Tip Dergisi / Dicle Medical Journal,2022,49(1):21-28.
[9] CHANDRA,N,DEY,S K,NARWAR,P.Management of intussusception in children:A comparative study of hydrostatic reduction with saline under ultrasound guidance versus laparoscopic assistance[J].Afr J Paediatr Surg,2023,20(3):171-175.
[10] HWANG J,YOON H M,KIM P H,et al.Current diagnosis and image-guided reduction for intussusception in children[J].Clin Exp Pediatr,2023,66(1):12-21.
[11] KURU S,KISMET K.Meckel's diverticulum:Clinical features,diagnosis and management[J].Rev Esp Enferm Dig,2018,110(11):726-732.
[12] 霍亚玲,郑彬,谷慧慧,等.高频超声对小儿梅克尔憩室的诊断价值及漏诊误诊分析[J].中国超声医学杂志,2019,35(1):29-31.
[13] 董娟,秦鸣,陈玉龙,等.儿童美克尔憩室继发肠套叠超声特点及漏诊误诊分析[J].中国超声医学杂志,2018,34(11):1049-1051.
[14] ZHANG L,CHEN X,HUANG Y,et al.Epidemiological characteristics,treatment,and outcomes of 586 cases of intussusception:A 4-year retrospective study in China[J].Front Pediatr,2024(12):1379168.
[15] 冯蔚,王峥嵘,马亚,等.儿童梅克尔憩室索带继发急性肠梗阻超声表现[J].中国医学影像技术,2023,39(11):1675-1678.
[16] ZHANG X,PING H,ZHANG J,et al.Intestinal obstruction caused by mesodiverticular band in children:A cohort study[J].Pediatr Surg Int,2023,39(1):163.
[17] LAI D D,LOW X Z,LEE Y Y,et al.A rare case of small bowel obstruction in a 15-year-old girl:Internal hernia associated with meckel's diverticulum[J].Am J Case Rep,2024(25):e943071.
[18] KAFSHGARI R,MAJD A R,LEDARI A T.Meckel's diverticulum axial torsion:A rare complication case report of a 5-year-old girl[J].Int J Surg Case Rep,2023(103):107883.
[19] KOURA S,URBIK V,OVERMAN R,et al.Spontaneous perforation of Meckel's diverticulum causing a partial small bowel obstruction:A case report[J].J Neonatal Surg,2023(12):7.