婴儿先天性肥厚性幽门狭窄临床特征

Clinical features of congenital hypertrophic pyloric stenosis

目的探讨婴儿先天性肥厚性幽门狭窄(congenital hypertrophic pyloric stenosis,CHPS)的临床发病特点,为该病诊治及流行病学调查提供依据。方法对307例CHPS住院患儿的病历资料进行回顾性总结和分析,观察项目包括患儿性别、发病年龄、体重变化、入院时电解质及动脉血气、B超检查结果及合并其他先天性疾病情况。将发病10d内治疗者列为早期组,超过10d者列为晚期组,比较这两组动脉血气、电解质及日平均体重增加的差别。结果 307例患儿中男性262例,女性45例,发病年龄1～351d,去掉离散程度较大者6例,其余301例平均发病年龄(23.8±13.0)d。患儿出生体重(3.24±0.44)kg(1.6～4.5kg);合并其他先天性疾病62例(20.2%)。幽门环肌B超厚度为(5.4±1.1)mm(3～8mm)。早期组日平均体重增加明显大于晚期组,而低钾血症、低氯血症及高碳酸血症发生率明显低于晚期组(P<0.05);血钠与血pH值无显著性差异。结论婴儿CHPS以男性为主,发病年龄为3～5周,幽门环肌厚度(5.4±1.1)mm,合并其他先天性疾病比例较高。对于在出生后3～5周内出现持续性呕吐患儿,应高度警惕CHPS,并应尽快诊治,以减少低氯低钾性碱中毒的发生;避免病情进一步恶化。

Objective To explore the clinical features of congenital hypertrophic pyloric stenosis（CHPS）in Chinese Han population,provide the evidence for diagnosis,treatment and epidemiological investigation.Methods Three hundred and seven hospitalized patients with CHPS were retrospectively reviewed,and data including patient＇s sex,onset age,body weight,other coexisting congenital defects,pyloric muscle thickness（evaluated by ultrasonograph）,serum electrolytes concentration and results of arterial blood gas analysis on admission were collected.According to the duration between first onset and admission,the patients were divided into two groups：early group（less than or equal to 10 days）and later group（more than 10 days）.The arterial blood gas,serum electrolyte concentration and average daily weight gain were compared between the two groups.Results There were 262 male and 45 female in 307 patients,the onset age ranged between 1 and 351 days,after 6 extreme cases were excluded,the mean onset age of the remaining 301 cases was 23.8±13.0 days.The birth weight was（3.24±0.44）kg（1.6～4.5 kg）;coexisting congenital defects were found in 62 cases（20.2%）.Pyloric muscle thickness was（5.4±1.1）mm（3～8 mm）.For early group,the rates of hypokalemia,hypochloraemia and hypercapnia were significantly lower than those of later group,while the daily weight increase was significantly greater.Conclusions In Chinese Han population,the onset age of CHPS is 3～5 weeks.The mean pyloric circular muscle thickness is（5.4±1.1）mm,and one-fifths of the patients are accompanied with other congenital difects.For infants with persistent vomiting at the age of 3～5 weeks should be considered CHPS,and go to hospital as soon as possible in order to reduce the incidence of hypokalemia,hypochloraemia and Hypercapnia,and avoid deterioration.