小儿消化道化学性烧伤后瘢痕性幽门狭窄的外科治疗

Surgical management of pyloric stenosis induced by gastrointestinal chemical burn in children

目的探讨小儿消化道化学性烧伤后瘢痕性幽门狭窄的外科治疗效果。方法回顾性分析2008年4月至2012年10月间广州市妇女儿童医疗中心收治的11例化学性烧伤后瘢痕性幽门狭窄患儿的临床资料。所有患儿均经规范的内科治疗和介入下球囊扩张及放置支架无效后，予以幽门切除并胃十二指肠吻合术。记录术中及术后情况。并比较术前1d与术后3月时患儿血清白蛋白、血红蛋白和转铁蛋白等营养指标。结果11例患儿男10例，女1例，平均年龄4．5岁。病变早期累及食管和胃，4周后集中在幽门。表现为瘢痕性幽门狭窄和完全性幽门梗阻。11例患儿均成功施行幽门切除并胃十二指肠吻合术，手术时间（134±26）min，术中出血量（5±2）ml，术后住院时间（10±3）d；无一例手术并发症出现。术后随访3个月，11例患儿均能正常进食，身高、体质量和智力发育正常，血清白蛋白、血红蛋白和转铁蛋白较术前显著改善（均P〈0．05）。术后6个月消化道钡餐显示，胃十二指肠吻合口通畅，无狭窄、溃疡等病变。结论幽门切除并胃十二指肠吻合术是治疗小儿化学性烧伤后瘢痕性幽门狭窄的有效治疗手段，近期效果良好。

Objective To investigate the efficacy of surgical management for pyloric stenosis induced by gastrointestinal chemical bum in children. Methods Clinical data of 11 children with pyloric stenosis induced by gastrointestinal chemical burn were analyzed retrospectively. After the failure of medicine, intervention of low balloon expansion and stent placement, they underwent pylorectomy and gastroduodenostomy. The body weight, height, serum albumin, hemoglobin, transferrin were compared between 1 day before and 3 months after operation. Results There were 10 males and 1 female with a mean age of 4.5 years old. The main cause of serious pyloric stenosis was the wrong intake of hydrochloric acid. Lesions involved the esophagus and stomach in the early stage, and 4 weeks later, the lesion mainly involved the pylorus, which resulted in scarring pylorie stenosis and complete pylorie obstruction. Pylorectomy and gastroduodenostomy was successfully performed. The mean operative time was （134~26） min. The estimated blood loss was （5＋2） ml. The postoperative length of stay was （10_＋3） d. There were no surgical complications. During the follow-up of 3 months, all the patients resumed regular diet. The height, body weight, and intelligence appeared to be normal. They showed significant improvement in weight, serum albumin, globulin, hemoglobin, transferrin at 3 months after the surgery（P〈0.05）. Six months after surgery, the anastomosis was shown to be nomal in barium follow through exam with no signs of stricture of ulcer. Conclusion Pylorectomy and gastroduodenostomy is an effective management for pyloric stenosis induced by gastrointestinal chemical burn in children, whose short-term efficacy is good.