腹壁牵引法与CO2气腹法腹腔镜幽门环肌切开术的比较  

Abdominal wall lifting vs carbon dioxide elicited pneumoperitoneum for laparoscopic pyloromyotomy

作　　者：王金湖[1] 钱云忠[1] 高志刚[1] 黄寿奖[1] 洪云霞[2] 钭金法[1] 潘涛[1] 熊启星[1] 

机构地区：[1]浙江大学医学院附属儿童医院普外科,杭州310003 [2]浙江大学医学院附属儿童医院麻醉科,杭州310003

出　　处：《中华小儿外科杂志》2009年第6期364-367,共4页Chinese Journal of Pediatric Surgery

基　　金：浙江省科技厅科研项目（项目编号：2004C33034）

摘　　要：目的比较腹壁牵引法与CO2气腹法两种幽门环肌切开术的优缺点，探讨腹壁牵引法幽门环肌切开术的应用价值。方法回顾分析2006年3月至2007年9月，我院普外科收治先天性肥厚性幽门狭窄病例66例，其中21例行腹壁牵引法腹腔镜幽门环肌切开术，45例行CO2气腹法腹腔镜幽门环肌切开术，比较两组患儿术中血气分析及生命体征监测的各项指标、术后并发症、住院时间及治疗费用。结果CO2气腹法组气腹10min后，pH值、PCO2、HCO3^-浓度较气腹前变化明显，差异有统计学意义（P〈0．05），MBP、HR较术前有升高，但差异无统计学意义（P〉0．05），SPO2改变不明显。腹壁牵引法组在Veress针穿刺10min后各个指标较术前均无明显变化。两组比较手术用时及术后偶发呕吐比例差异无统计学意义（P〉0．05），术后进食时间、术后呼吸道感染发生比例、住院天数、治疗费用差异均有统计学意义（P〈0．05）。结论腹壁牵引法腹腔镜幽门环肌切开术较传统气腹法腹腔镜手术更简便、经济，并发症相对少，有一定的应用价值。Objective To compare the two ways for laparoscopic pyloromyotomy and evaluate the clinical effects of gasless laparoscopic pyloromyotomy with abdominal wall lifting. Methods Sixtysix infants with congenital hypertrophic pyloric stenosis were referred to Children＇s hospital Zhejiang university school of medicine from Mar 2006 to Sep 2007. Among them,21 were performed laparoscopic pyloromyotomy with abdominal wall lifting（group A） ,45 were performed laparoscopic pyloromyotomy with pneumoperitoneum （group B）. Their vital signs and blood gas analysis during the operations, complications and cost were watched. Results Ten minutes after pneumoperitoneum beginning, the data of pH, PCO2 and HCO3 change a lot from the preoperative, there are statistically significant differences （P〈0. 05）. In group A, all data were stable and there is no statistically difference. The occasional vomiting rates of two groups are similar. There are statistically significant differences between the two groups at the respiratory tract infection rate, hospital days and medical cost（P〈0.05）. Conclusions Laparoscopic pyloromyotomy with abdominal wall lifting is a useful and effective method for congenital hypertrophic pylorie stenosis.

关 键 词：幽门狭窄 肥厚性 腹腔镜外科手术 气腹 人工 

分 类 号：R686[医药卫生—骨科学]