腹腔镜手术治疗先天性肥厚性幽门狭窄的疗效分析
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摘要
目的总结腹腔镜手术治疗先天性肥厚性幽门狭窄(CHPS)的手术经验及技巧。方法本研究收集2015年3月至2017年3月在本院经腹腔镜行幽门环肌切开术治疗的26例先天性肥厚性幽门狭窄患儿为研究对象,其中男童21例,女童5例,年龄15～59 d,平均32 d;体重2. 5～4. 8 kg,平均3. 4 kg。结果 26例均顺利完成腹腔镜手术,无术中及术后并发症发生。手术时间30～55 min,平均38 min。术后8～12 h拔除胃管并开始喂糖水,2～3 d过渡到全奶喂养。术后住院时间3～7 d,平均4 d。26例术后全部以门诊方式随访1～2年,术前呕吐症状消失,无切口感染或戳孔疝发生,无生长发育迟滞,无肠黏连及肠梗阻等近、远期并发症发生。结论腹腔镜手术治疗先天性肥厚性幽门狭窄具有微创、安全有效、恢复快及并发症少等优点,值得临床推广运用。
Objective To summarize the surgical techniques of laparoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis( CHPS). Methods Retrospective analysis was performed for 26 CHPS infants undergoing laparoscopic pyloromyotomy from March 2015 to March 2015. There were 21 boys and 5 girls with an average age of 32( 15 ～ 59) days and an average weight of 3. 4( 2. 5 ～ 4. 8) kg. Results All operations were accomplished smoothly without intraoperative and postoperative complications. The average operative duration was 38 min. After removing gastric tube,glucose solution was 8 ～ 12 h post-operation,2 ～ 3 d transit to milk feeding 2 ～ 3 days after operation. The average duration of postoperative hospital stay was 4( 3 ～ 7) days.During a follow-up period of 1 ～ 2 years,there was no onset of vomiting,incision infection,Trocar site hernia,growth retardation,intestinal adhesion/obstruction or other long-term complications. Conclusion Laparoscopic pyloromyotomy for CHPS is mini-invasive,safe and effective and offers a rapid recovery and fewer complications. It is worth clinical popularization.
Objective To summarize the surgical techniques of laparoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis( CHPS). Methods Retrospective analysis was performed for 26 CHPS infants undergoing laparoscopic pyloromyotomy from March 2015 to March 2015. There were 21 boys and 5 girls with an average age of 32( 15 ～ 59) days and an average weight of 3. 4( 2. 5 ～ 4. 8) kg. Results All operations were accomplished smoothly without intraoperative and postoperative complications. The average operative duration was 38 min. After removing gastric tube,glucose solution was 8 ～ 12 h post-operation,2 ～ 3 d transit to milk feeding 2 ～ 3 days after operation. The average duration of postoperative hospital stay was 4( 3 ～ 7) days.During a follow-up period of 1 ～ 2 years,there was no onset of vomiting,incision infection,Trocar site hernia,growth retardation,intestinal adhesion/obstruction or other long-term complications. Conclusion Laparoscopic pyloromyotomy for CHPS is mini-invasive,safe and effective and offers a rapid recovery and fewer complications. It is worth clinical popularization.
引文
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2 Alain JL,Grousseau D,Terrier G.Extramucosal pylorotomy by laparoscopy[J].J Pediatr Surg,1991,26(10):1191-1192.DOI:10.1016/0022-3468(91)90331-m.
3孙宁,郑珊.小儿外科学[M].北京:人民卫生出版社,2015:189.Sun N,Zheng S.Pediatric Surgery[M].Beijing:People's Medical Publishing House,2015:189.
4张金哲,杨啟政,刘贵麟.中华小儿外科学[M].郑州:郑州大学出版社,2006:468.Zhang JZ,Yang QZ,Liu GL.Chinese Pediatric Surgery[M].Zhengzhou:Zhengzhou University Press,2006:468.
6谢向东.超声联合X线诊断先天性肥厚性幽门狭窄的临床价值[J].齐齐哈尔医学院学报,2011,32(7):1067-1068.DOI:10.3969/j.issn.1002-1256.2011.07.028.Xie XD.Clinical value of ultrasound plus radiology in the diagnosis of congenital hypertrophy pylorus stenosis[J].Journal of Qiqihar University of Medicine,2011,32(7):1067-1068.DOI:10.3969/j.issn.1002-1256.2011.07.028.
7刘辉,林琼,傅忠,等.超声诊断先天性肥厚性幽门狭窄20例[J].临床小儿外科杂志,2007,6(2):46-47.DOI:10.3969/j.issn.1671-6353.2007.02.017.Liu H,Lin Q,Fu Z,et al.Ultrasonic diagnosis of congenital hypertrophic pylorus stenosis:a report of 20 cases[J].J Clin Ped Sur,2007,6(2):46-47.DOI:10.3969/j.issn.1671-6353.2007.02.017.
8陈兴和,李笃妙,张建星.腹腔镜与开腹幽门环肌切开术的优越性分析[J].现代诊断与治疗,2014,25(22):5171-5172.Chen XH,Li DM,Zhang JX.Analysis of superiority of laparoscopy versus laparotomy[J].Mod Diagn Treat,2014,25(22):5171-5172.
9马立东,李春雷,周福金.腹腔镜与小斜切口手术治疗肥厚性幽门狭窄[J].临床小儿外科杂志,2016,15(1):97-99.DOI:10.3969/j.issn.1671-6353.2016.01.029.Ma LD,Li CL,Zhou FJ.Laparoscopy and small oblique incision surgery for hypertrophic pyloric stenosis[J].J Clin Ped Sur,2016,15(1):97-99.DOI:10.3969/j.issn.1671-6353.2016.01.029.
10李吉昌,刘绍玲,马进财,等.高频超声与X线钡剂造影对先天性肥厚性幽门狭窄诊断及分型的价值[J].中华超声影像学杂志,2008,17(11):969-972.DOI:10.3321/j.issn:1004-4477.2008.11.013.Li JC,Liu SL,Ma JC,et al.Application value of high-frequency ultrasound and radiological barium meal examination in the diagnosis and subtyping of congenital hypertrophic pyloric stenosis[J].Chin J Ultrasonogr,2008,17(11):969-972.DOI:10.3321/j.issn:1004-4477.2008.11.013.
11郑珊.实用新生儿外科学[M].北京:人民卫生出版社,2013:398.Zheng S.Practical Neonatal Surgery[M].Beijing:People's Medical Publishing House,2013:398.
12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.DOI:10.3969/j.issn.1009-5551.2013.06.028.Li WF,Guo CM,Li CW,et al.Clinical value of laparoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis[J].Journal of Xinjiang Medical University,2013,36(6):825-827.DOI:10.3969/j.issn.1009-5551.2013.06.028.
13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].中华实用儿科杂志,2013,28(18):1433-1436.DOI:10.3760/cma.j.issn.2095-428X.2013.18.0 21.Li WF,Ma Z,Li CW,et al.Efficacy and safety of laparoscopic pyloromyotomy versus open pyloromyotomy for congenital hypertrophic pyloric stenosis:Meta analysis[J].Chin J Appl Cli Pediatr,2013,28(18):1433-1436.DOI:10.3760/cma.j.issn.2095-428X.2013.18.021.
14董贺龙,马海峰,李春雷,等.腹腔镜幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄79例[J].沈阳医学院学报,2014,16(2):76-78.DOI:10.3969/j.issn.1008-2344.2014.02.005.Dong HL,Ma HF,Li CL,et al.Laparoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis:a report of 79cases[J].Journal of Shenyang Medical College,2014,16(2):76-78 DOI:10.3969/j.issn.1008-2344.2014.02.005.
15陈卫兵,李炳,王寿青,等.单孔腹腔镜幽门环肌切开术与传统腹腔镜手术的比较[J].中华胃肠外科,2013,16(6):589.DOI:10.3760/cma.j.issn.1671-0274.2013.06.023.Chen WB,Li B,Wang SQ,et al.Comparison of laparoscopic pyloric myotomy with traditional laparoscopic surgery[J].Chin J of Gastrointest Surg,2013,16(6):589.DOI:10.3760/cma.j.issn.1671-0274.2013.06.023.
2 Alain JL,Grousseau D,Terrier G.Extramucosal pylorotomy by laparoscopy[J].J Pediatr Surg,1991,26(10):1191-1192.DOI:10.1016/0022-3468(91)90331-m.
3孙宁,郑珊.小儿外科学[M].北京:人民卫生出版社,2015:189.Sun N,Zheng S.Pediatric Surgery[M].Beijing:People's Medical Publishing House,2015:189.
4张金哲,杨啟政,刘贵麟.中华小儿外科学[M].郑州:郑州大学出版社,2006:468.Zhang JZ,Yang QZ,Liu GL.Chinese Pediatric Surgery[M].Zhengzhou:Zhengzhou University Press,2006:468.
6谢向东.超声联合X线诊断先天性肥厚性幽门狭窄的临床价值[J].齐齐哈尔医学院学报,2011,32(7):1067-1068.DOI:10.3969/j.issn.1002-1256.2011.07.028.Xie XD.Clinical value of ultrasound plus radiology in the diagnosis of congenital hypertrophy pylorus stenosis[J].Journal of Qiqihar University of Medicine,2011,32(7):1067-1068.DOI:10.3969/j.issn.1002-1256.2011.07.028.
7刘辉,林琼,傅忠,等.超声诊断先天性肥厚性幽门狭窄20例[J].临床小儿外科杂志,2007,6(2):46-47.DOI:10.3969/j.issn.1671-6353.2007.02.017.Liu H,Lin Q,Fu Z,et al.Ultrasonic diagnosis of congenital hypertrophic pylorus stenosis:a report of 20 cases[J].J Clin Ped Sur,2007,6(2):46-47.DOI:10.3969/j.issn.1671-6353.2007.02.017.
8陈兴和,李笃妙,张建星.腹腔镜与开腹幽门环肌切开术的优越性分析[J].现代诊断与治疗,2014,25(22):5171-5172.Chen XH,Li DM,Zhang JX.Analysis of superiority of laparoscopy versus laparotomy[J].Mod Diagn Treat,2014,25(22):5171-5172.
9马立东,李春雷,周福金.腹腔镜与小斜切口手术治疗肥厚性幽门狭窄[J].临床小儿外科杂志,2016,15(1):97-99.DOI:10.3969/j.issn.1671-6353.2016.01.029.Ma LD,Li CL,Zhou FJ.Laparoscopy and small oblique incision surgery for hypertrophic pyloric stenosis[J].J Clin Ped Sur,2016,15(1):97-99.DOI:10.3969/j.issn.1671-6353.2016.01.029.
10李吉昌,刘绍玲,马进财,等.高频超声与X线钡剂造影对先天性肥厚性幽门狭窄诊断及分型的价值[J].中华超声影像学杂志,2008,17(11):969-972.DOI:10.3321/j.issn:1004-4477.2008.11.013.Li JC,Liu SL,Ma JC,et al.Application value of high-frequency ultrasound and radiological barium meal examination in the diagnosis and subtyping of congenital hypertrophic pyloric stenosis[J].Chin J Ultrasonogr,2008,17(11):969-972.DOI:10.3321/j.issn:1004-4477.2008.11.013.
11郑珊.实用新生儿外科学[M].北京:人民卫生出版社,2013:398.Zheng S.Practical Neonatal Surgery[M].Beijing:People's Medical Publishing House,2013:398.
12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.DOI:10.3969/j.issn.1009-5551.2013.06.028.Li WF,Guo CM,Li CW,et al.Clinical value of laparoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis[J].Journal of Xinjiang Medical University,2013,36(6):825-827.DOI:10.3969/j.issn.1009-5551.2013.06.028.
13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].中华实用儿科杂志,2013,28(18):1433-1436.DOI:10.3760/cma.j.issn.2095-428X.2013.18.0 21.Li WF,Ma Z,Li CW,et al.Efficacy and safety of laparoscopic pyloromyotomy versus open pyloromyotomy for congenital hypertrophic pyloric stenosis:Meta analysis[J].Chin J Appl Cli Pediatr,2013,28(18):1433-1436.DOI:10.3760/cma.j.issn.2095-428X.2013.18.021.
14董贺龙,马海峰,李春雷,等.腹腔镜幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄79例[J].沈阳医学院学报,2014,16(2):76-78.DOI:10.3969/j.issn.1008-2344.2014.02.005.Dong HL,Ma HF,Li CL,et al.Laparoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis:a report of 79cases[J].Journal of Shenyang Medical College,2014,16(2):76-78 DOI:10.3969/j.issn.1008-2344.2014.02.005.
15陈卫兵,李炳,王寿青,等.单孔腹腔镜幽门环肌切开术与传统腹腔镜手术的比较[J].中华胃肠外科,2013,16(6):589.DOI:10.3760/cma.j.issn.1671-0274.2013.06.023.Chen WB,Li B,Wang SQ,et al.Comparison of laparoscopic pyloric myotomy with traditional laparoscopic surgery[J].Chin J of Gastrointest Surg,2013,16(6):589.DOI:10.3760/cma.j.issn.1671-0274.2013.06.023.