先天性肥厚性幽门狭窄经胃镜下幽门环肌切开术后的影像学变化

Iconography change of congenital hypertrophic pyloric stenosis after gastroscopic pyloromyotomy

目的观察胃镜下幽门环肌切开术治疗先天性肥厚性幽门狭窄(CHPS)前后幽门梗阻的变化情况。方法 2006年8月—2011年5月入住我院新生儿科,临床表现为呕吐、胃型和胃蠕动波、右上腹扪及幽门橄榄,结合造影、B超结果,符合CHPS诊断标准的44例患儿,其中男39例,女5例,胎龄34.5～41周,年龄14～85天,体重2.2～6.5 kg。44例患儿在胃镜下幽门环肌切开术治疗前及治疗后7～14天均进行泛影葡胺上消化道造影。观察手术前后幽门的异常影像学特征与梗阻程度的变化。结果①异常影像学特征:治疗前:线样征33例,鸟嘴征29例,双轨征26例,肩征15例,多同时合并出现。治疗后:线样征6例,双轨征2例,鸟嘴征5例,肩征3例。异常影像学特征在治疗后显著减少。②梗阻程度:治疗前:Ⅰ度梗阻8例,Ⅱ梗阻11例,Ⅲ梗阻25例。治疗后:无梗阻34例,Ⅰ度梗阻6例,Ⅱ度梗阻4例,Ⅲ度梗阻0例。结论上消化道造影是诊断CHPS的重要方法,能观察治疗前后胃和幽门的形态、幽门通畅度的变化,可以作为疗效评价的客观指标。

Objective To observe the pyloric obstruction change of congenital hypertrophic pyloric stenosis（CHPS） before and after treatment by endoscopic pyloromyotomy.Methods 44 infants were in line with the diagnostic criteria of CHPS,whose clinical manifestations were vomiting,gastric type and gastric peristaltic wave,right upper quadrant palpable pyloric olive.They were diagnosed as CHPS by upper gastroenterography and ultrasonic-results.The 44 infants were from August 2006 to May 2011 in hospital,including 39 males and 5 females,aged from 14 to 85 days,weight from 2.2 to 6.5 kg,gestational age from 34.5 to 41 weeks.They were made upper gastroenterography before and after treatment.Observation index is the characteristics of abnormal images and the pyloric obstruction degree in preoperative and postoperative.Results ①Abnormal image features ： Before treatment： 33 infants（75.0%） were line-like sign,29 cases（65.6%） with beak sign,26 cases（59.4%） with double-track sign,and 15 cases（34.4%） with shoulder sign,more complicated with there.After treatment： 6 cases with line-like sign,2 cases wiht double-track sign,5 cases with beak sign,3 cases with shoulder sign.Abnormal imaging features were significantly reduced after treatment.②The degree of obstruction：Before treatment： 8 patients with little obstruction,11 cases with moderate obstruction,25 cases with severe obstruction.After treatment： 34 cases without obstruction,6 patients with little obstruction,4 cases with moderate obstruction,0 cases with severe obstruction.Conclusion Upper gastroenterography is an important method of diagnosis of CHPS.We not only can observe the form of the stomach and pylorus,and the change of pyloric patency before and after treatment by the images,but also can use it as a objective indicators of efficacy evaluation.