探讨儿童美克尔憩室(MD)并发症的临床特点。

选择2012年2月至2017年2月，于苏州大学附属儿童医院就诊的92例MD患儿为研究对象，其年龄为2个月至13岁7个月。按照MD患儿并发症不同，将其分为肠梗阻组(n＝33)、便血组(n＝44)和憩室炎组(n＝15)。采用回顾性分析方法，收集3组患儿的年龄、性别等一般临床资料，以及并发症、憩室长度与直径比值(HDR)、MD与回盲瓣距离、胃黏膜异位率等临床资料。采用方差分析，对3组患儿的憩室HDR、MD与回盲瓣的距离等进行统计学分析，再采用SNK-q法进一步进行两两比较。采用Kruskal-Wallis H秩和检验，对3组患儿的年龄进行统计学分析。采用χ²检验，对3组患儿的性别构成比、胃黏膜异位率等进行统计学分析。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》的要求。

① 92例MD患儿中，并发无痛性便血者为44例(47.8%)，并发肠梗阻者为33例(35.9%)，并发憩室炎者为15例(16.3%)。②3组MD患儿年龄、性别构成比等一般临床资料比较，差异均无统计学意义(P>0.05)。③肠梗阻组、便血组、憩室炎组患儿憩室HDR分别为(1.8±0.9)、(2.7±1.3)、(1.9±1.4)，3组患儿憩室HDR整体比较，差异有统计学意义(F＝5.391，P＝0.006)，进一步进行两两比较的结果显示，便血组憩室HDR分别高于肠梗阻组和憩室炎组，组间比较，差异均有统计学意义(P<0.05)，而肠梗阻组与憩室炎组憩室HDR比较，差异无统计学意义(P>0.05)。肠梗阻组、便血组、憩室炎组患儿MD与回盲瓣距离分别为(44.2±15.1) cm、(52.6±13.8) cm、(39.7±16.9) cm，3组患儿MD与回盲瓣距离整体比较，差异有统计学意义(F＝5.464，P＝0.006)，进一步进行两两比较的结果显示，便血组MD与回盲瓣距离分别远于肠梗阻组和憩室炎组，组间比较，差异均有统计学意义(P<0.05)，而肠梗阻组与憩室炎组MD与回盲瓣距离比较，差异无统计学意义(P>0.05)。④肠梗阻组、便血组、憩室炎组患儿胃黏膜异位率分别为12.1%(4/33)、86.4%(38/44)、20.0%(3/15)，3组胃黏膜异位率比较，差异有统计学意义(χ²＝47.590，P<0.001)。⑤92例MD患儿中，仅1例(1.1%)患儿死亡。

儿童MD并发症以无痛性便血和肠梗阻为主，憩室HDR及憩室位置与MD并发症相关。MD患儿中，并发无痛性便血者的憩室HDR较大，而且其MD与回盲瓣距离较远。

To investigate the clinical features of complications of Meckel diverticulum (MD) in children.

A total of 92 cases of children with MD who were admitted to the Children′s Hospital of Soochow University from February 2012 to February 2017 were selected as study subjects. Their age ranged from 2 months to 13 years and 7 months. According to different complications of children with MD, they were divided into intestinal obstruction group (n=33), painless hematochezia group (n=44) and diverticulitis group (n=15). The general clinical data such as age and gender of three groups were collected by retrospective analysis method, as well as complications, diverticulum height-to-diameter ratio (HDR), the distance from MD to ileocecal valve, and the ectopic rate of gastric mucosa. The diverticulum HDR and the distance from MD to ileocecal valve were statistically analyzed by one-way ANOVA, and SNK-q method was used to further compare among different groups. The age among 3 groups was statistically compared by Kruskal-Wallis H rank sum test. Constituent ratio of gender and ectopic rate of gastric mucosa among 3 groups were statistically analyzed by chi-square test. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013.

①Among 92 MD children, 44 cases (47.8%) of them had painless hematochezia, 33 cases (35.9%) of them had intestinal obstruction, 15 cases (16.3%) of them had diverticulitis. ②There were no significant differences among 3 groups in the general clinical data, such as age and constituent ratio of gender (P>0.05). ③The diverticulum HDR of intestinal obstruction group, hematochezia group and diverticulitis group were (1.8±0.9), (2.7±1.3), and (1.9±1.4), respectively, and there was statistical difference among 3 groups in the diverticulum HDR (F=5.391, P=0.006). Further comparisons showed that diverticulum HDR in hematochezia group was higher than that in intestinal obstruction group and diverticulitis group, respectively, and both the differences were statistically significant (P<0.05), but there was no significant difference between intestinal obstruction group and diverticulitis group in diverticulum HDR (P>0.05). The distances from MD to ileocecal valve of intestinal obstruction group, hematochezia group and diverticulitis group were (44.2±15.1) cm, (52.6±13.8) cm, and (39.7±16.9) cm, respectively, and the overall comparison of distances from MD to ileocecal valve among 3 groups was statistically significant (F=5.464, P=0.006). The results of further comparisons showed that the distance from MD to ileocecal valve in hematochezia group was much greater than that in intestinal obstruction group and diverticulitis group, respectively, and there were statistically significant differences (P<0.05), but there was no significant difference between intestinal obstruction group and diverticulitis group (P>0.05). ④The ectopic rate of gastric mucosa in intestinal obstruction group, hematochezia group and diverticulitis group were 12.1% (4/33), 86.4% (38/44), and 20.0% (3/15), respectively, and there was statistically significant difference among 3 groups in the ectopic rate of gastric mucosa of MD children (χ²=47.590, P<0.001). ⑤Among the 92 children with MD, only 1 child (1.1%) died.

Painless hematochezia and intestinal obstruction are the main complications of children with MD, and diverticulum HDR and clinical location of diverticulum are associated with complications of MD. The diverticulum HDR is higher and the distance from MD to ileocolic valve is longer in children with MD who complicated with painless hematochezia.