腹腔镜下幽门肌切开术治疗CHPS的临床分析  

Laparoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis

作　　者：程明[1] 樊剑锋[1] 王达丰[1] 

机构地区：[1]南京医科大学附属无锡市儿童医院儿外科,无锡214023

出　　处：《中华腔镜外科杂志（电子版）》2014年第5期51-52,共2页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的：探讨腹腔镜下幽门肌切开术治疗先天性肥厚性幽门狭窄（CHPS）的临床疗效。方法选取2012年5月－2014年3月期间我院共收治的采用腹腔镜下幽门肌切开术治疗36例CHPS 患儿，经脐轮上缘偏右侧的弧形切口，直视下置入一次性利用的5 rnm Trocar，建立气腹，置入30°视镜。在左右上腹部利用11号刀片各戳出一个3 mm 腹壁戳孔，经左侧戳孔直接置入肠钳固定幽门管，右侧戳孔先后直接置入幽门肌切开刀和幽门肌分离钳，完成幽门肌切开术。结果本组36例CHPS 患儿均在腹腔镜下完成手术，无中转开腹，手术时间25～61 min，平均36 min，术后3～6 d 出院。随访3～6个月，生长发育均恢复正常。结论初学腹腔镜下幽门肌切开术，需要一定的知识储备和腹腔镜的手术操作经验，并牢记手术注意事项和技巧。Objective To summarize the beginners′experience of laparoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis （CHPS）.Methods Selecting 36 cases of children with CHPS were treated by laparoscopic pylorus myotomy treated in our hospital during May 2012 to Mar.2014,A 5 mm trocar through a incision at the higher border of the umbilical ring was placed under direct vision for the insertion of camera.Two 3 mm working instruments were inserted directly into the abdomen via separate lateral incisions.A intestinal clamp was inserted through the left incision to manipulate the gastric wall near the pylorus.Through the right incision,a retractable pyloromyotomy scalpel and a dissecting forceps were in turn utilized to complete pyloromyotomy.Results The pyloromyotomy was completed successfully under laparoscope in all 36 cases,with an operation time of 25-61 min （mean 36 min）,without a conversion to open surgery.The patients were discharged at 3-6 postoperative days.All discharged patients were followed up for 3-6 months and normally developed.Conclusion The knowledge reserve,precautions and technical skills of laparoscopic pyloromyotomy for infants with CHPS were need for beginners.

关 键 词：肥厚性幽门狭窄 幽门肌切开术 腹腔镜 

分 类 号：R726.5[医药卫生—儿科]