腹腔镜早期诊治先天性胃壁肌层缺损  

Early diagnosis and laparoscopic treatment of congenital gastric wall muscular defect

作　　者：赵宝红[1] 任红霞[1] 孙小兵[1] 吴晓霞[1] 靳园园[1] 刘文跃[1] 赵亮[1] 张晖 孙雪[1] 郭鑫 Zhao Baohong;Ren Hongxia;Sun Xiaobing;Wu Xiaoxia;Jin Yuanyuan;Liu Wenyue;Zhao Liang;Zhang Hui;Sun Xue;Guo Xin(Department of Neonatal Surgery,Shanxi Children's Hospital,Taiyuan,030013,China)

机构地区：[1]山西省儿童医院新生儿外科,太原030013

出　　处：《中华小儿外科杂志》2020年第2期162-165,共4页Chinese Journal of Pediatric Surgery

基　　金：山西省重点研发计划项目(201803D31181)。

摘　　要：目的初步探讨先天性胃壁肌层缺损在未发生胃破裂之前的临床特点,以及腹腔镜在胃破裂之前早期诊治该病的应用价值。方法分析我院2018年经腹腔镜诊治的2例新生儿先天性胃壁肌层缺损患儿的病例资料。男、女各1例,男性患儿为足月儿,女性患儿为早产儿(胎龄分别为38+2周、34周),日龄分别为3 d、4 d,体重分别为2540g、1800g,2例患儿均以腹胀入院,均有自主排便,感染指标均在正常范围内,腹部X线片均表现出巨大胃泡影,胃肠减压无效,行上消化道造影均提示胃蠕动能力减弱,造影剂无法通过幽门。2例患儿均行腹腔镜探查术,术中均证实为先天性胃壁肌层缺损且未穿孔,2例均同时在腹腔镜下行胃壁修补术。结果2例患儿术后恢复良好,术后无任何感染征象,术后1周行上消化道造影无吻合口漏等相关并发症,胃壁形态及蠕动能力正常,逐步开奶后痊愈出院。检索中国知网(CNKI)、万方、维普、Pubmed、Clinicalkey、Google Scholar等数据库截至2018年12月,未检索到在未发生胃破裂之前,腹腔镜诊治先天性胃壁肌层缺损的相关报道。结论1.对呕吐、拒奶、上腹膨隆、有胃型、X线检查显示巨大胃泡影、胃肠减压后胃泡影变化不明显且上消化道造影提示胃蠕动能力减弱的新生儿,要高度怀疑先天性胃壁肌层缺损,可以考虑腹腔镜探查;2.腹腔镜在先天性胃壁肌层缺损尚未导致胃破裂之前进行早期诊断和治疗,可避免胃破裂后感染性休克、败血症等严重并发症的发生,且效果满意。Objective To summarize the clinical features of congenital gastric wall muscular defect and explore the role of laparoscopy in its early diagnosis and treatment prior to gastric rupture in neonates.Methods Clinical parameters of two neonates with congenital gastric wall muscular defect undergoing laparoscopy in 2018 were analyzed.There were 13-day-old full-term boy and 14-day-old premature girl with a gestational age of 38+2 and 34 weeks and a body weight of 2540 and 1800 grams.Both cases were characterized by abdominal distension and self-defecation.All infection parameters were normal.Abdominal radiology indicated a giant gastric bubble and gastrointestinal decompression was ineffective.Upper gastroenterography showed decreased gastric peristalsis and obstruction of contrast media through pylorus.During laparoscopic exploration,congenital gastric wall muscular defect was confirmed without perforation.Then laparoscopic gastric wall repair was performed.Results There was no obvious sign of postoperative infection or anastomotic leakage.At Week 1 post-operatively,upper gastroenterography showed that both gastric wall shape and peristalsis ability were normal.After gradual feeding,there was no vomiting or other discomforts before discharging.The database searches of CNKI,Wanfang,CQVIP,Pubmed,Clinicalkey and Google Scholar up until December 2018 yielded no report of laparoscopy in early diagnosis and treatment of congenital gastric wall muscular defect prior to gastric rupture.Conclusions For doubtful cases congenital gastric wall muscular defect with imaging evidence of decreased gastric peristalsis,an exploration of laparoscopy is recommended.And laparoscopy lowers the risks of such serious complications as septicemia and infectious shock after gastric rupture.

关 键 词：腹腔镜 胃壁肌层缺损 先天性 婴儿·新生 

分 类 号：R722[医药卫生—儿科]