彩色多普勒超声评估胃镜下幽门肌切开术治疗先天性肥厚性幽门狭窄的疗效研究
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摘要
目的探讨彩色多普勒超声技术评估胃镜下幽门肌切开术治疗先天性肥厚性幽门狭窄(CHPS)疗效的临床价值。方法应用彩色多普勒超声对65例确诊为CHPS患儿(CHPS组)和50例正常健康婴儿(对照组)的幽门进行检测,比较两组幽门肌层和黏膜层的厚度、血流分级情况。观察CHPS患儿术前和术后1 d、1周、1个月、6个月时幽门管各层组织的血流分布及血流参数变化,以及造影剂通过幽门管情况和幽门管内径变化情况。结果 CHPS组与对照组的肌层和黏膜层厚度,肌层和黏膜层血流分级比较,差异均有统计学意义(均P<0.01)。与术前比较,CHPS组术后1 d黏膜层血流更丰富;术后1周及1个月幽门管内径增宽,肌层变薄,术后6个月肌层厚度进一步变薄,肌层、黏膜层血流较术前减少,肌层动脉收缩期峰值血流速度减慢,阻力指数减小,差异均有统计学意义(均P<0.05)。结论应用彩色多普勒超声可观察CHPS患儿胃镜下幽门肌切开术后幽门管各层组织血流变化规律,并可通过测量肌层动脉收缩期峰值血流速度及阻力指数以协助估计幽门狭窄的程度,评估手术疗效。
Objective To explore the clinical value of color Doppler ultrasound in the evaluation of the curative effect of pylorotomy under gastroscopy in the treatment of congenital hypertrophic pyloric stenosis(CHPS).Methods A total of 65 children with CHPS and 50 control infants were examined by color Doppler ultrasound.The thickness and blood flow grading of pyloric muscular layer and mucosal layer were compared.The changes of blood flow distribution and parameters of pyloric duct in children with CHPS before operation and 1 d,1 week,1 month and 6 months after gastroscopic pylorectomy were observed and compared.The changes of contrast medium passing through pyloric duct and pyloric duct diameter were observed.Results The thickness and blood flow grading of muscular layer and mucosal layer were statistically significant between CHPS group and control group(all P<0.01).Compared with preoperation,blood flow in mucosa increased at 1 d after operation in CHPS group.The pyloric diameter became wider and the muscular layer became thinner 1 week and 1 month after operation.The thickness of muscular layer further decreased,blood flow of muscular layer and mucosal layer reduced,Vmax and RI of muscle layer decreased 6 months after operation(all P<0.05).Conclusion Color Doppler ultrasound can be used to observe the changes of blood flow grading of pyloric canal mucosa,and estimate the degree of pyloric stenosis by measuring Vmax and RI after gastroscopic pylorotomy in CHPS children.It provides valuable clinical evidence for evaluating the effect of surgical treatment.
Objective To explore the clinical value of color Doppler ultrasound in the evaluation of the curative effect of pylorotomy under gastroscopy in the treatment of congenital hypertrophic pyloric stenosis(CHPS).Methods A total of 65 children with CHPS and 50 control infants were examined by color Doppler ultrasound.The thickness and blood flow grading of pyloric muscular layer and mucosal layer were compared.The changes of blood flow distribution and parameters of pyloric duct in children with CHPS before operation and 1 d,1 week,1 month and 6 months after gastroscopic pylorectomy were observed and compared.The changes of contrast medium passing through pyloric duct and pyloric duct diameter were observed.Results The thickness and blood flow grading of muscular layer and mucosal layer were statistically significant between CHPS group and control group(all P<0.01).Compared with preoperation,blood flow in mucosa increased at 1 d after operation in CHPS group.The pyloric diameter became wider and the muscular layer became thinner 1 week and 1 month after operation.The thickness of muscular layer further decreased,blood flow of muscular layer and mucosal layer reduced,Vmax and RI of muscle layer decreased 6 months after operation(all P<0.05).Conclusion Color Doppler ultrasound can be used to observe the changes of blood flow grading of pyloric canal mucosa,and estimate the degree of pyloric stenosis by measuring Vmax and RI after gastroscopic pylorotomy in CHPS children.It provides valuable clinical evidence for evaluating the effect of surgical treatment.
引文
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[10] Jenssen C,Tuma J,M觟ller K,et al.Ultrasound artifacts and their diagnostic significance in internal medicine and gastroenterology-part 2:color and spectral Doppler artifacts[J].Z Gastroenterol,2016,54(6):569-578.
[11]高海港,苏光明,周保成.彩色多普勒伪像观察在监测输尿管导管位置中的应用价值[J].临床军医杂志,2012,40(4):935-937.
[12]肖雪,张又祥,蔡本龙,等.胃镜下幽门肌切开术对先天性肥厚性幽门狭窄患儿幽门部黏膜影响的研究[J].广州医药,2015,46(5):68-70.
[13] Ford WD,Crameri JA,Holland AJ.The learning curve for laparoscopic pyloromyotomy[J].J Pediatr Surg,1997,32(4):552-554.
[2] Gotley LM,Blanch A,Kimble R,et al.Pyloric stenosis:a retrospective study of an Australian population[J].Emerg Med Australas,2009,21(1):407-413.
[3] Sola JE,Neville HL.Laparoscopic vs open pyloromyotomy:a systematic review and meta-analysis[J].J Pediatr Surg,2009,44(8):1631-1637.
[4] Hemanz-Schulman M,Zhu Y,Stein SM,et al.Hypertrophic pyloric stenosis in infants:US evaluation of vascularity of the pyloric canal[J].Radiology,2003,229(2):389-393.
[5]黎庆宁,聂玉强,张又祥,等.超细胃镜治疗先天性肥厚性幽门狭窄9例[J].中国消化内镜,2008,2(3):9-11.
[6] Chao HC.Update on endoscopic management of gastric outlet obstruction in children[J].World J Gastrointest Endosc,2016,8(18):635-645.
[7] Kawai M,Peretta S,Burckhardt O,et al.Endoscopic pyloromyotomy:a new concept of minimally invasive surgery for pyloric stenosis[J].Endoscopy,2012,44(2):169-173.
[8] Ma S,Liu J,Zhang Y,et al.Application of color Doppler ultrasound combined with Doppler imaging artifacts in the diagnosis and estimate of congenital hypertrophic pyloric stenosis[J].Sci Rep,2017,7(1):9527.
[9] Tan HL,Blythe A,Kirby CP,et al.Gastric foveolar cell hyperplasia and its role in postoperative vomiting in patients with infantile hypertrophic pyloric stenosis[J].Eur J Pediatr Surg,2009,19(2):76-78.
[10] Jenssen C,Tuma J,M觟ller K,et al.Ultrasound artifacts and their diagnostic significance in internal medicine and gastroenterology-part 2:color and spectral Doppler artifacts[J].Z Gastroenterol,2016,54(6):569-578.
[11]高海港,苏光明,周保成.彩色多普勒伪像观察在监测输尿管导管位置中的应用价值[J].临床军医杂志,2012,40(4):935-937.
[12]肖雪,张又祥,蔡本龙,等.胃镜下幽门肌切开术对先天性肥厚性幽门狭窄患儿幽门部黏膜影响的研究[J].广州医药,2015,46(5):68-70.
[13] Ford WD,Crameri JA,Holland AJ.The learning curve for laparoscopic pyloromyotomy[J].J Pediatr Surg,1997,32(4):552-554.