非肥厚性幽门梗阻的外科治疗策略  

Surgical treatment strategy for non-hypertrophic pyloric stenosis

作　　者：罗先勇[1] 王家祥[1] 陈新让[1] 李苏宁[1] 夏自强[1] 陈浩[1] 高鹏飞[1] 

机构地区：[1]郑州大学第一附属医院小儿外科,450052

出　　处：《中华小儿外科杂志》2013年第10期741-745,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨非肥厚性幽门狭窄的诊断、治疗方法及手术方式的选择。方法回顾性研究我院2007年4月至2012年4月收治的110例儿童幽门梗阻，其中非先天性肥厚性幽门梗阻18例。2例幽门痉挛，2例幽门前瓣膜，9例水肿瘢痕性幽门狭窄，3例溃疡性幽门狭窄，1例幽门肿瘤，1例Jodhpu病。总结非肥厚性幽门梗阻的典型症状及治疗特点。结果有明确病因者5例。本组4例保守治疗，1例介入下置人空场营养管后继续保守治疗，1例介入下球囊扩张术，余12例均行手术治疗，手术组术前明确诊断者4例。手术方式采取幽门成形术、瓣膜切除＋幽门成形术、胃十二指肠吻合术（BillrothI式吻合）、胃空肠Roux-en-Y吻合术，随访0．5～5．5年，平均（2．47±2．0）年，呕吐症状消失15例，饱食后偶出现呕吐3例。结论非肥厚性幽门梗阻临床类型较多，术前明确病因诊断较困难，治疗方式多样，对于儿童幽门管切除、迷走神经切断应慎重考虑，以减少倾倒综合征及胃排空障碍的发生，建议针对溃疡及肿瘤病变可切除幽门管，其余均可保守治疗或行幽门成形术、胃空肠Roux-en-Y吻合术等替代手术。Objective To evaluate the diagnosis and surgical treatment for non-hypertrophic pyloric stenosis （NHPS）. Methods Clinical data of 110 cases of pyloric stenosis, treated during April 2007 to April 2012 in our hospital, were analyzed and evaluated retrospectivelly. In this group, 18 cases were diagnosed as NHPS, which includes 2 cases of pylorospasm, 2 cases of prepyloric membrane, 9 cases of pyloric stenosis caused by edema, 3 cases complicated with peptic ulcer, 1 case of pyloric tumor and lcase of Jodhpu disease. The typical symptoms and therapy strategies of non- hypertrophic pyloric stenosis were summarized. Results In the 5 cases with definite causes, 4 cases were treated by conservative therapy, 1 case continued conservative therapy after placing jejunum feeding tube under interventional radiography, 1 case underwent balloon dilatation under interventional radiography~ the remaining 12 cases were treated by surgery. Only 4 cases got correct diagnosis before operation. Pyloroplasty, membrane excision or pyloroplasty, gastroduodenostomy （Billroth I anastomosis）, Roux-en-Y gastrojejunostomy were applied to these patients. Vomiting disappeared in 15 cases and occasionally occurred with full stomach in 3 cases during the follow up of 0.5 to 5.5 years （2. 47 ± 2. 0 years on average）. Conclusions Non-hypertrophic pyloric stenosis can be caused by various diseases, which is difficult to be diagnosed before surgery. Surgical treatment options should be chosen based on the variety of the causes.

关 键 词：幽门梗阻 胃肠吻合术 吻合术 Roux-en-Y 

分 类 号：R726.5[医药卫生—儿科]