腹腔镜下幽门肌切开术治疗CHPS的临床分析
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摘要
目的探讨腹腔镜下幽门肌切开术治疗先天性肥厚性幽门狭窄(CHPS)的临床疗效。方法选取2012年5月-2014年3月期间我院共收治的采用腹腔镜下幽门肌切开术治疗36例CHPS患儿,经脐轮上缘偏右侧的弧形切口,直视下置入一次性利用的5 rnm Trocar,建立气腹,置入30°视镜。在左右上腹部利用11号刀片各戳出一个3 mm腹壁戳孔,经左侧戳孔直接置入肠钳固定幽门管,右侧戳孔先后直接置入幽门肌切开刀和幽门肌分离钳,完成幽门肌切开术。结果本组36例CHPS患儿均在腹腔镜下完成手术,无中转开腹,手术时间25~61 min,平均36 min,术后3~6 d出院。随访3~6个月,生长发育均恢复正常。结论初学腹腔镜下幽门肌切开术,需要一定的知识储备和腹腔镜的手术操作经验,并牢记手术注意事项和技巧。
Objective To summarize the beginners' experience of laparoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis( CHPS). Methods Selecting 36 cases of children with CHPS were treated by laparoscopic pylorus myotomy treated in our hospital during May 2012 to Mar. 2014,A 5 mm trocar through a incision at the higher border of the umbilical ring was placed under direct vision for the insertion of camera. Two 3 mm working instruments were inserted directly into the abdomen via separate lateral incisions. A intestinal clamp was inserted through the left incision to manipulate the gastric wall near the pylorus. Through the right incision,a retractable pyloromyotomy scalpel and a dissecting forceps were in turn utilized to complete pyloromyotomy. Results The pyloromyotomy was completed successfully under laparoscope in all 36 cases,with an operation time of 25-61 min( mean 36 min),without a conversion to open surgery. The patients were discharged at 3-6 postoperative days. All discharged patients were followed up for 3-6 months and normally developed. Conclusion The knowledge reserve,precautions and technical skills of laparoscopic pyloromyotomy for infants with CHPS were need for beginners.
Objective To summarize the beginners' experience of laparoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis( CHPS). Methods Selecting 36 cases of children with CHPS were treated by laparoscopic pylorus myotomy treated in our hospital during May 2012 to Mar. 2014,A 5 mm trocar through a incision at the higher border of the umbilical ring was placed under direct vision for the insertion of camera. Two 3 mm working instruments were inserted directly into the abdomen via separate lateral incisions. A intestinal clamp was inserted through the left incision to manipulate the gastric wall near the pylorus. Through the right incision,a retractable pyloromyotomy scalpel and a dissecting forceps were in turn utilized to complete pyloromyotomy. Results The pyloromyotomy was completed successfully under laparoscope in all 36 cases,with an operation time of 25-61 min( mean 36 min),without a conversion to open surgery. The patients were discharged at 3-6 postoperative days. All discharged patients were followed up for 3-6 months and normally developed. Conclusion The knowledge reserve,precautions and technical skills of laparoscopic pyloromyotomy for infants with CHPS were need for beginners.
引文
1 Alain JL,Grousseau D,Terrier G.Extramucosal pyloromyotomy by laparoscopy[J].Surg Endosc,1991,5(4):174-175.
2 刘向阳,陈磊,李洪涛,等.腹腔镜治疗先天性肥厚性幽门狭窄的体会[J].中国微创外科杂志,2012,12(9):860-861.
3 St Peter SD,Holcomb GW,Calkins CM,et al.Open versus laparoscopic pyloromyotomy for plyoric stenosis:A prospective,randomized trial[J].Ann Surg,2006,122(244):363-370.
4 刘玉献.腹腔镜治疗小儿先天性肥厚性幽门狭窄的临床疗效评估[J].中国现代药物应用,2013,7(14):37-38.
5 高林,李炳,蔡久英.经脐单腔道腹腔镜治疗先天性肥厚性幽门狭窄14例围术期护理[J].齐鲁护理杂志,2013,19(2):70-72.
6 Hall NJ,Van Der Zee J,Tan HL,et al.Meta-analysis of laparoscopic versus open pyloromyotomy[J].Ann Surg,2004,120(240):774-778.
7 於林军,黄民燕,罗春芬,等.腹腔镜下幽门环肌切开术治疗先天性肥厚性幽门狭窄17例[J].实用医学杂志,2008,24(2):242-243.
8 Ramstedt C.Zur operation der angelborenen pylorus-stenose[J].Med Klin,1912,28(8):1702-1705.
9 严志龙,洪莉,胡明,等.腹腔镜治疗幽门肥厚性狭窄[J].中华小儿外科杂志,2010,31(8):638-639.
10 李万福,郭晨明,李朝旺,等.腹腔镜幽门环肌切开术治疗先天性肥厚性幽门狭窄的临床应用[J].新疆医科大学学报,2013,36(6):825-827.
11 陈卫兵,李炳,王寿青,等.单孔腹腔镜幽门肌切开术与传统腹腔镜手术的比较[J].中华胃肠外科杂志,2013,16(6):589.
12 李万福,马柱,李朝旺,等.腹腔镜幽门环肌切开术与开腹手术治疗先天性肥厚性幽门狭窄有效性和安全性Meta分析[J].中华实用儿科临床杂志,2013,28(18):1433-1436
2 刘向阳,陈磊,李洪涛,等.腹腔镜治疗先天性肥厚性幽门狭窄的体会[J].中国微创外科杂志,2012,12(9):860-861.
3 St Peter SD,Holcomb GW,Calkins CM,et al.Open versus laparoscopic pyloromyotomy for plyoric stenosis:A prospective,randomized trial[J].Ann Surg,2006,122(244):363-370.
4 刘玉献.腹腔镜治疗小儿先天性肥厚性幽门狭窄的临床疗效评估[J].中国现代药物应用,2013,7(14):37-38.
5 高林,李炳,蔡久英.经脐单腔道腹腔镜治疗先天性肥厚性幽门狭窄14例围术期护理[J].齐鲁护理杂志,2013,19(2):70-72.
6 Hall NJ,Van Der Zee J,Tan HL,et al.Meta-analysis of laparoscopic versus open pyloromyotomy[J].Ann Surg,2004,120(240):774-778.
7 於林军,黄民燕,罗春芬,等.腹腔镜下幽门环肌切开术治疗先天性肥厚性幽门狭窄17例[J].实用医学杂志,2008,24(2):242-243.
8 Ramstedt C.Zur operation der angelborenen pylorus-stenose[J].Med Klin,1912,28(8):1702-1705.
9 严志龙,洪莉,胡明,等.腹腔镜治疗幽门肥厚性狭窄[J].中华小儿外科杂志,2010,31(8):638-639.
10 李万福,郭晨明,李朝旺,等.腹腔镜幽门环肌切开术治疗先天性肥厚性幽门狭窄的临床应用[J].新疆医科大学学报,2013,36(6):825-827.
11 陈卫兵,李炳,王寿青,等.单孔腹腔镜幽门肌切开术与传统腹腔镜手术的比较[J].中华胃肠外科杂志,2013,16(6):589.
12 李万福,马柱,李朝旺,等.腹腔镜幽门环肌切开术与开腹手术治疗先天性肥厚性幽门狭窄有效性和安全性Meta分析[J].中华实用儿科临床杂志,2013,28(18):1433-1436