腹腔镜治疗肥厚性幽门狭窄25例分析  

Laparoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis: Report of 25 cases

作　　者：浦晓[1] 樊剑锋[1] 石英佐[1] 朱晓敏[1] 

机构地区：[1]南京医科大学附属无锡市儿童医院儿外科,214023

出　　处：《中华普外科手术学杂志（电子版）》2015年第5期77-79,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜治疗肥厚性幽门狭窄（HPS）的临床疗效及初学者在手术过程中需注意的技巧。方法选取2012年5月至2013年11月期间我院应用腹腔镜下幽门环肌切开术治疗的HPS25例患者。环脐轮上缘开放式置入5mm Trocar，建立气腹，置入30°腹腔镜，在左、右上腹各戳出一3mm腹壁切口，直接置人操作器械，左侧置人无损伤抓钳夹近幽门处胃壁，右侧先后置入幽门肌切开刀和幽门肌分离钳，完成幽门环肌切开术。术后每2周门诊随访1次，2个月后改为每个月1次，直至添加辅食为止。监测患儿术后完成奶量，呕吐情况，体重增长及大便情况。结果腹腔镜下完成手术25例，无中转开腹，手术时间25～56min，平均38min。术后第1天，开始喂奶。3～6d出院。术后随访1—6个月，生长发育均恢复正常。25例患儿中，1例（4％）患者脐部切口感染。术后3个月体重可接近同年龄正常儿童。结论腹腔镜治疗肥厚性幽门狭窄具有良好疗效。初学者学习和开展腹腔镜下幽门肌切开术，需要掌握一定的操作方法和技巧。Objective To summarize the initial experience with laparoscopic pyloromyotomy for patients with congenital hypertrophic pylorie stenosis （CHPS）. Methods From May 2012 to November 2013, 25 patients with CHPS received laparoscopie pyloromyotomyin our hospital. A 5mm trocar was placed under direct vision at the superior margin of the umbilical ring for the insertion of camera and a pneumoperitoneum was established. Two 3-mm incisions were made at both lateral superior belly for the insertion of instruments. A non-traumatic grasping forceps was inserted through the left incision to manipulate the gastric wall near the pylorus. Through the fight incision, a retractable pyloromyotomy scalpel and a dissecting forceps were in turn utilized for the pyloromyotomy. The patients were followed up once 2 weeks after the operation, and once 1 month after two months. We monitored these babies＇ milk intake , vomiting, weight gain and defecate. Results All of 25 patients underwent successfully laparoscopic surgery without conversion, with operation time ranging from 25 to 56 minutes（ mean, 38 minutes）. Oral feeding of milk was attempted on the 1st day postoperatively. The patients were discharged at 3 -6 days postoperatively with a follow-up of 1 -6 months. All of the 25 patients grew normally. Among them, 1 （4%） showed incision infection. All the patients regained normal weight 3 months after surgery. Conclusions Laparoscopie pyloromyotomy could be satisfactory in treating patients with congenital hypertrophic pyloric stenosis. For beginners, technical skills of laparoseopie pyloromyotomy should be mastered in the management of infants with HPS.

关 键 词：幽门狭窄 肥厚性 腹腔镜检查 

分 类 号：R726.5[医药卫生—儿科]