腹腔镜幽门环肌切开术82例报告

Laparoscopic pyloromyotomy: a report of 82 cases

目的：探讨腹腔镜幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄的临床疗效及操作技巧。方法：回顾分析2011年1月至2014年6月我院为82例先天性肥厚性幽门狭窄患儿行腹腔镜幽门环肌切开术的临床资料,其中男65例,女17例,15～183 d,平均（45.0±5.5）d,体重2.0～5.2 kg,平均体重（3.0±0.3）kg。临床表现为进行性加重的喷射性呕吐,呕吐物为奶及奶块,不含胆汁。术前B超示：幽门肌层厚度0.4～0.6 cm,并行上消化道造影示：幽门管呈鸟嘴样改变,确诊为先天性肥厚性幽门狭窄。结果：82例手术均顺利完成,无一例中转开腹。手术时间20～50 min,平均（30±5）min,术后4～6 h即可进食糖水15～30 ml,2 h无呕吐给予等量母乳,术后48 h恢复正常喂养,平均住院（6±1）d,无一例发生切口感染等并发症。术后随访1～24个月,患儿体重增加,发育良好。结论：腹腔镜幽门环肌切开术操作安全有效,具有进食早、手术创伤小、康复快、美容效果好等优势,值得推广应用。

Objective：To discuss the clinical efficacy and operating skills of laparoscopic pyloromyotomy to treat congenital hy- pertrophic pyloric stenosis for children. Methods： The clinical data of the 82 children with congenital hypertrophic pyloric stenosis who were treated by laparoscopic pyloromyotomy were retrospectively analyzed from Jan. 2011 to Jun. 2014, including 65 males and 17 females, with an age range of 15-183 d, average was （45± 5.5 ） d, and a body weight range of 2.0-5.2 kg, average was （ 3.0 ± 0.3 ） kg. The clinical manifestation was progressive spray vomiting, the vomitus was milk and milk block without bile. The diagnosis was based on the pylorus circular layer which was 0.4-0.6 cm detected by the uhrasonnd and the beak-like pyloric canal which was observed by up- per gastrointestinal contrast. Results ： All the 82 operations were successfully completed, none of them was converted to open procedure. The operative time was 20-50 rain,mean time was （30 ±5） min,and the patients could be fed with 15-30 ml sugar water in 4-6 h after operation. Same amount of breast milk could be given in 2 h if no vomiting was found. The patients could be put back on normal feeding in 48 h after operation. The average hospital stay was （6± 1 ） d. None of those cases had complications such as incision infection. The 1-24 months follow-up showed that patients gained weight and developed well. Conelusions： Laparoscopic pyloromyotomy is safe and effective. The treatment has advantages of earlier eating, more minimal invasion, faster recovery and fewer scars left. This procedure should be popularized.