幽门凿在经脐单部位腹腔镜幽门环肌切开术中的应用
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摘要
目的:探讨幽门凿在经脐单部位腹腔镜幽门环肌切开术中的应用价值。方法:收集2011年2月至2016年3月台州医院小儿外科收治的应用幽门切开刀治疗的先天性肥厚性幽门狭窄患儿28例(幽门刀组)以及2016年6月至2018年1月应用幽门凿手术治疗的患儿30例(幽门凿组)的病历资料,比较2组手术时间、手术并发症发生情况等。结果:与幽门刀组相比,幽门凿组手术时间较短[(21.2±3.9)minvs.(36.8±7.3)min,t=-10.048,P<0.001],并发症较少[幽门凿组1例vs.幽门刀组7例,χ~2=4.041,P=0.044]。幽门刀组2例幽门黏膜破裂(均中转开腹行黏膜修补术),5例幽门浆膜撕裂,幽门凿组1例幽门浆膜撕裂。所有病例随访1年,生长发育均良好。结论:在经脐单部位腹腔镜治疗肥厚性幽门狭窄中,应用幽门凿比幽门刀效率更高,更安全。
Objective: To investigate the value of pyloric chisel in transumbilical single-site laparoscopic pyloromyotomy. Methods: Pyloric incision knife was applied in 28 cases of congenital hypertrophic pyloric stenosis from Feb. 2011 to Mar. 2016(knife group) and 30 children were treated by pyloric chisel from Jun.2016 to Jan. 2018(chisel group). The operative time and complications were compared between the two groups.Results: The operative time was shorter in the pyloric chisel group than the knife group [(21.2±3.9) min vs.(36.8±7.3) min, t=-10.048, P<0.001]. The complications were fewer in the pyloric chisel group than the knife group(χ~2=4.041, P=0.044). There were 2 cases of mucosal perforations that had to perform abdominal surgery in the knife group. Five cases of serous tearing were found in the knife group but only one in the pyloric chisel group. All cases were followed up for 1 year and all children were normally developed. Conclusion: Compared wtih pyloric incision knife, pyloric chisel is more efficient and safer in the surgery of transumbilical single-site laparoscopic pyloromyotomy.
Objective: To investigate the value of pyloric chisel in transumbilical single-site laparoscopic pyloromyotomy. Methods: Pyloric incision knife was applied in 28 cases of congenital hypertrophic pyloric stenosis from Feb. 2011 to Mar. 2016(knife group) and 30 children were treated by pyloric chisel from Jun.2016 to Jan. 2018(chisel group). The operative time and complications were compared between the two groups.Results: The operative time was shorter in the pyloric chisel group than the knife group [(21.2±3.9) min vs.(36.8±7.3) min, t=-10.048, P<0.001]. The complications were fewer in the pyloric chisel group than the knife group(χ~2=4.041, P=0.044). There were 2 cases of mucosal perforations that had to perform abdominal surgery in the knife group. Five cases of serous tearing were found in the knife group but only one in the pyloric chisel group. All cases were followed up for 1 year and all children were normally developed. Conclusion: Compared wtih pyloric incision knife, pyloric chisel is more efficient and safer in the surgery of transumbilical single-site laparoscopic pyloromyotomy.
引文
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[12]李炳,陈卫兵,王寿青,等.单部位腹腔镜治疗小于三周的先天性肥厚性幽门狭窄[J].中华小儿外科杂志,2014,35(1):43-46.
[13]王炜林,张宜兵,尙克磊,等.腹腔镜手术治疗先天性肥厚性幽门狭窄46例[J].安徽医学,2016,37(4):463-464.
[14]陈伟明,何秋明,王哲,等.自制切拨电刀在腹腔镜治疗先天性肥厚性幽门狭窄中的应用[J].中华小儿外科杂志,2019,40(2):118-121.
[2]STPETER S D,ACHER C W,SHAH S R,et al.Parental and volunteer perception of pyloromyotomy scars:comparing laparoscopic,open,and nonsurgical volunteers[J].J Laparoendosc Adv Surg Tech A,2016,26(4):305-308.
[3]陈永卫,侯大为.腹腔镜幽门环肌切开术治疗先天性肥厚性幽门狭窄[J].中华小儿外科杂志,1999,20(6):343-344.
[4]MUENSTERER O J,ADIBE O O,HARMON C M,et al.Single-incision laparoscopic pyloromyotomy:initial experience[J].Surg Endosc,2010,24(7):1589-1593.
[5]KOZLOV Y,NOVOGILOV V,PODKAMENEV A,et al.Single-incision laparoscopic surgery for pyloric stenosis[J].Pediatr Surg Int,2012,28(4):347-350.
[6]AURéLIEN B,KLIPFEL C,MEIGNAN P,et al.Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis:a survey of 407 children[J].Pediatr Surg Int,2018,34:421-426.
[7]RICH B S,CREASY J,AFANEH C,et al.The international experience of single-incision pediatric endosurgery:current state of the art[J].J Laparoendosc Adv Surg Tech A,2013,24(1):43-49.
[8]TROBS R B,VAHDAD M R,CERNAIANU G.Transumbilical cord access(TUCA)for laparoscopy in infants and children:simple,safe and fast[J].Surg Today,2015,46(2):235-240.
[9]邢福中,鲁巍,伍兴,等.经脐入路腹腔镜手术治疗先天性肥厚性幽门狭窄[J].中华小儿外科杂志,2012,33(8):637-638.
[10]MUENSTERER O J.Single-incision pediatric endosurgical(sipes)versus conventional laparoscopic pyloromyotomy:A single-surgeon experience[J].J Gastrointest Surg,2010,14(6):965-968.
[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):589-592.
[12]李炳,陈卫兵,王寿青,等.单部位腹腔镜治疗小于三周的先天性肥厚性幽门狭窄[J].中华小儿外科杂志,2014,35(1):43-46.
[13]王炜林,张宜兵,尙克磊,等.腹腔镜手术治疗先天性肥厚性幽门狭窄46例[J].安徽医学,2016,37(4):463-464.
[14]陈伟明,何秋明,王哲,等.自制切拨电刀在腹腔镜治疗先天性肥厚性幽门狭窄中的应用[J].中华小儿外科杂志,2019,40(2):118-121.