胃镜下幽门肌切开术治疗先天性肥厚性幽门狭窄  

Treatment of congenital hypertrophic pyloric stenosis with endoscopic pyloromyotomy

作　　者：张又祥[1] 聂玉强[2] 肖雪[1] 喻宁芬[1] 黎庆宁[2] 邓礼[1] 

机构地区：[1]广州市第一人民医院儿科,510180 [2]广州市第一人民医院消化内科,510180

出　　处：《中华儿科杂志》2008年第4期247-251,共5页Chinese Journal of Pediatrics

摘　　要：目的探讨胃镜下幽门肌切开术治疗先天性肥厚性幽门狭窄（CHPS）。方法具有典型临床表现，结合B超、胃肠造影和胃镜确诊为CHPS的9例患儿，男7例，女2例，年龄26～70d，体重2．65～6．10kg。在胃镜室，经苯巴比妥钠和咪达唑仑镇静后，直径5．9mm电子胃镜经口入胃，通过幽门达十二指肠降段。在胃镜直视下，使用弓形乳头肌切开刀和针式切开刀，按球部一胃窦方向，电切狭窄幽门管前壁和后壁肥厚的黏膜及环形肌，以暴露纵形肌为标志，深度2～4mm。术中使用吸引和去泡剂。结果术后胃镜容易通过幽门。B超及造影显示液体顺利通过幽门。术后2～10h喂养，呕吐次数和呕吐量均显著减少，8例在1周内消失，1例呕吐持续1个月。无胃肠道穿孔、大出血等严重并发症。随访2～9个月，8例经1次治疗痊愈，1例呕吐停止1个月后复发，经第2次治疗痊愈。结论胃镜下幽门肌切开术治疗CHPS是有效而安全的。该方法不用开腹手术，操作简便，不良反应少，恢复喂养快。Objective To evaluate the effect of the treatment of congenital hypertrophic pyloric stenosis （CHPS） with endoscopic pyloromyotomy. Method Nine consecutive infants （7 boys, 2 girls; age range 26～70 days; weight range 2. 65～6. 10 kg） , with a diagnosis of CHPS according to typical clinical manifestations, transabdominal ultrasound （US）, gastroenterography and gastroscope. All the cases had accompanying malnutrition, anaemia, metabolic alkalosis, and some were complicated with congenital heart disease. In gastroscope operating room, all the patients were given pentobarbital and midazolam intravenously. A gastroscope with an outer diameter of 5.9 mm was passed through mouth, stomach, pylorus to the descending segment of duodenum. Under gastroscopy, two incisions were made along the anterior and posterior wall of pylorus from the duodenal bulb to the antrum by using endoscopic electrosurgical needle knife and an arch sphincter sarcotom. Incisions were deepened by 2 to 3 procedures until the longitudinal muscle was exposed, about 2 to 4 mm according to transabdominal US performed before operation. The incision depth was 2 ～ 3 mm if pylorus wall was 4 ～ 6 mm in thickness; or 3 ～ 4 mm when the wall was thicker than 6 mm. Result The endoscope was easily passed through the pylorus to the duodenum postoperation. The transabdominal US and gastroenterography showed that liquid easily flew through pylorus. All patients were able to have regular feeding about 2 to 10 hours after the operation. Vomiting in all patients was significandy decreased in frequency and amount, and in 8 infants vomiting stopped within 1 week, in one case it did not stop until 1 month after the treatment. Some cases showed slight adverse reaction, no perforation or massive haemorrhage in stomach or intestines occurred in any of the patients during and post- operation. Eight infants were doing well at follow-up （range 2 to 9 months）. One girl had recurred vomiting at normal feeding after a period of 1 month postoperation without

关 键 词：幽门狭窄 肥厚性 括约肌切开术 内窥镜 儿童 

分 类 号：R686[医药卫生—骨科学]