超声评价胃镜下幽门括约肌切开术治疗先天性肥厚性幽门狭窄术后并发呕吐的价值  

Value of ultrasound for evaluation of postoperative vomiting as a complication of endoscopic sphincterotomy in the treatment of congenital hypertrophic pyloric stenosis

作　　者：罗环千[1] 张又祥[2] 柳建华[1] 马穗红[1] 翁志媛[2] 肖雪[2] 

机构地区：[1]广州医学院附属广州市第一人民医院功能检查科,510180 [2]广州医学院附属广州市第一人民医院儿科,510180

出　　处：《中华生物医学工程杂志》2011年第2期174-177,共4页Chinese Journal of Biomedical Engineering

基　　金：广州市科技计划支撑项目（200921-E381-01）

摘　　要：目的 探讨超声评价胃镜下幽门括约肌切开术治疗先天性肥厚性幽门狭窄（CHPS）术后并发症呕吐的价值.方法 回顾性分析2006年1月至2009年11月本院胃镜下行幽门括约肌切开术治疗的30例CHPS患儿术后是否出现呕吐咖啡色内容物的并发症及治疗情况和超声检查资料包括幽门管长度和形态结构特征、黏膜层（含黏膜下层）及肌层的厚度、幽门管随胃蠕动波到达时的开放情况.结果 30例中4例患儿术后未出现呕吐并发症（A组）;26例术后出现呕吐并发症,其中17例经常规保守治疗后明显好转或消失（B组）,9例术后经保守治疗后无效,需再次手术（C组）.B、C组共有16例术后呕吐咖啡色内容物,经常规保守治疗后消失.A、B、C 3组患儿超声检测术前后黏膜层厚度差异均无统计学意义;A、C组幽门管长径、B、C组幽门肌厚度术后1周与术前相比差异无统计学意义;A组幽门肌厚度与B组幽门管长径术后1周较术前有所减小[A组：（9.03＋2.67）mm比（8.38±2.59）mm,B组：（18.70±3.90）mm比（16.66±3.00）mm,均P＜0.05].A组患儿幽门管开放良好;B组患儿幽门管腔始终未显示明显开放,仅少量液体由黏膜间隙通过;C组患儿幽门排空延迟,偶见缝隙样微开.B、C组16例呕吐咖啡色内容物的患儿中超声仅显示2例幽门管切开部位的黏膜有凹槽,10例无呕吐咖啡色内容物的患儿中也有2例显示切开部位黏膜层有小凹槽.结论 超声可明确CHPS术后呕吐的不同病因并指导进一步治疗,但不能诊断呕吐咖啡色内容物的原因.Objective To investigate the value of ultrasound for evaluation of postoperative vomiting as a complication of endoscopic sphincterotomy in the treatment of congenital hypertrophic pyloric stenosis（CHPS）.Methods A review of 30 pediatric cases of CHPS in our hospital from January 2006 to November 2009 was conducted on postoperative coffee-ground vomiting and related treatment.as well as study with ultrasound regarding the length and morphological characteristics of the pyloric canal,thickness of the mucous layer（including submucosa）and the muscular layer,and patency of the pyloric canal upon arrival of gastric peristaltic wave.Results Except for 4 children（group A）,26 of the 30 children presented postoperative vomiting,of whom,17 experienced obvious relief or resolution with conventional conservative treatment （group B） , whereas the remaining 9 did not respond and subsequently needed a second operation （group C）. Postoperative coffee-ground vomit was noted in a total of 16 patients from group B or C, which disappeared with conservative treatment. There was no statistical difference in thickness of raucous layer of children among the groups A, B and C before operation and one week after operation, nor was in length of pyloric canal between groups A and C, and in thickness of pyloric muscular layer between groups B and C. The pyloric muscular layer in group A or the length of pyloric canal in group B was significantly reduced at one week after operation as compared with before operation [group A：（9.03±2.67） mm vs （8.38±2.59） mm, group B：（18.70±3.90） mm vs（16.66±3.00） mm, all P〈0.05]. The patency of pyloric canal was well in group A, inadequate in group B （with minimal passage of fluids through pylorus） , and poor in group C （delayed emptying of the stomach with occasional opening of a slit-like pylorus）. Only 2 of 16 patients with coffee-group vomiting from group B or C showed grooves at the mucosa of pylorus canal where incision was performed, as did only anoth

关 键 词：超声检查 幽门狭窄 肥厚性 呕吐 胃镜检查 括约肌切开术 内镜 

分 类 号：R726.5[医药卫生—儿科]