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目的探讨经脐单部位腹腔镜对小儿出血性梅克尔憩室的诊断及治疗价值。方法 2011年6月至2015年3月对出血性梅克尔憩室18例行经脐单部位腹腔镜下梅克尔憩室切除术。18例患儿均有间歇性便血病史,术前行胃镜、结肠镜、B超检查,排除上消化道、肛管结肠出血和肠套叠,未明确出血原因;术前~(99m)Tc同位素扫描,11例在右下腹显示放射物聚集,7例未显示放射物聚集,~(99m)Tc同位素扫描阳性率不高。结果 18例患儿均行经脐单部位腹腔镜手术,探查发现梅克尔憩室,成功行憩室切除,无中转开腹。手术时间40~80 min,平均57.3 min;术中失血2~8 ml,平均3.8 ml;术后25 h内恢复肠功能,1~2 d排便,切口均愈合良好,疤痕不明显,术后4~7 d出院。病理结果为异位的胃黏膜组织。无1例手术相关并发症发生。随访6个月~2年,未再出现便血,生长发育正常。结论经脐单部位腹腔镜技术,具有能直接进行诊断及治疗,肚脐处血管神经较少,减少机体的损伤和疼痛,切口小、恢复快、术后不显露瘢痕、术后并发症少等优点,经脐单部位腹腔镜治疗小儿梅克尔憩室安全、有效,技术可行。
Objective To investigate the diagnosis and treatment of hemorrhagic Merkel diverticulum with single-site laparoscopy via umbilical cord. Methods From June 2011 to March 2015, 18 patients with hemorrhagic Merkel diverticulitis underwent laparoscopic Merck diverticulum excision via single-site umbilical laparoscopic surgery. Eighteen infants had a history of intermittent hematochezia. Gastroscopy, colonoscopy and B-mode ultrasonography were performed preoperatively to exclude upper gastrointestinal and anal canal hemorrhage and intussusception without definite cause of bleeding. Preoperative ~ (99m) Tc isotopes Scanning, 11 cases showed radioactive accumulation in the right lower quadrant, 7 cases did not show radioactive accumulation, ~ (99m) Tc isotope scan positive rate is not high. Results 18 cases of children underwent single-site transabdominal laparoscopic surgery, exploration found Merkel diverticulum, successful diverticulum resection, no laparotomy. The operative time was 40-80 min (average 57.3 min). The intraoperative blood loss was 2-8 ml (mean, 3.8 ml). The bowel function was recovered within 25 h after operation and defecation was performed within 1-2 days. The incisions healed well and the scar was not obvious. ~ 7 d discharged. Pathological results for the ectopic gastric mucosa. No case of surgery-related complications occurred. Follow-up 6 months to 2 years, no recurrence of blood in the stool, normal growth and development. Conclusion The single-site laparoscopic transesophageal umbilical technique has the advantages of direct diagnosis and treatment, fewer vascular nerves at the umbilicus, less damage and pain, less incision, faster recovery, less scar after surgery, less postoperative complications , Single umbilical laparoscopic treatment of children Merkel diverticulum safe, effective and technically feasible.