单部位腹腔镜治疗小于三周的先天性肥厚性幽门狭窄  

Single-site umbilical laparoscopic pyloromyotomy for hypertrophic pyloric stenosis in infants less than 3 weeks

作　　者：李炳 陈卫兵 王寿青 夏顺林 刁美[2] 李龙[2] 

机构地区：[1]江苏省淮安市妇女儿童医院小儿外科,223002 [2]首都儿科研究所外科

出　　处：《中华小儿外科杂志》2014年第1期43-46,共4页Chinese Journal of Pediatric Surgery

基　　金：国家十一五科技支撑计划课题（2006BA105A06）

摘　　要：目的腹腔镜治疗小于3周的先天性肥厚性幽门狭窄患儿13例，探讨该方法的初步经验和临床应用价值。方法回顾分析本研究组2010年1月至2013年1月应用腹腔镜治疗小于3周的先天性肥厚性幽门狭窄患儿13例，男12例，女1例，年龄11～21d（平均17．3d）。术前行B型超声检查，必要时配合上消化道造影明确诊断后，经脐单部位腹腔镜完成幽门环肌切开术。结果对121例先天性肥厚性幽门狭窄患儿进行腹腔镜治疗，其中小于3周的患儿13例，幽门肌的厚度为（3．6±0．35）mm，幽门管的长度为（15．8±2．8）mm。手术时间15～30min，平均26min，无中转常规腹腔镜手术和开放手术。术后随访3～38个月（平均16．5个月），脐部无可视性瘢痕，患儿生长发育良好。结论超声检查经典的诊断标准用于小于3周的先天性肥厚性幽门狭窄患儿并不精确，3周以下患儿幽门肌的厚度及幽门管的长度常小于经典诊断标准。经脐单部位腹腔镜手术治疗该类患儿并不延长手术时间，术后恢复快，美容效果较经典腹腔镜手术更佳。Objective To report our initial experiences and the potential benefits of this technique in 13 eases. Methods A retrospective review of single-site umbilical laparoseopic pyloromyotomy was performed for hypertrophic pyloric stenosis less than 3 weeks between January 2010 and January 2013. Of the 13 patients, 12 were males and 1 was female, aged 11 to 21 d （average 17. 3 d）. After the diagnosis was confirmed by ultrasound and upper gastrointestinal study, single-site umbilical laparoscopic pyloromyotomy was performed. Results One hundred and twenty-one cases underwent a laparoseopic pyloromyotomy for hypertrophic pyloric stenosis, 13 cases were less than 3 weeks with pyloric length of （15.8 ± 2. 8） mm and thickness of （3.6 ±0. 35） mm. The operative time was 15-30 min（mean 26 rain）. There was no conversion to open operation or standard laparoscopy. The cases were followed up for 3-38 months （mean 16. 5 months）, and all the cases were doing well. Collelusions Our experience suggests that the routine sonographic diagnostic criteria are not always precise in the infants with hypertrophic pyloric stenosis less than 3 weeks, because they have shorter and thinner pylorus than their older counterparts. The single-she umbilical laparoseopie pyloromyotomy is simple, with better cosmetic results, and similar operative time compared to the standard laparoscopic surgery.

关 键 词：腹腔镜检查 幽门肥厚性狭窄 新生儿 

分 类 号：R726.5[医药卫生—儿科]