自制切拨电刀在腹腔镜治疗先天性肥厚性幽门狭窄中的应用

Application of specialized blade-shaped electrosurgical electrode in the laparoscopic treatment of congenital hypertrophic pyloric stenosis

目的总结自制切拨电刀在腹腔镜治疗先天性肥厚性幽门狭窄中的应用效果。方法回顾性分析2015年3月至2016年6月泉州市儿童医院小儿外科在腹腔镜下幽门环肌切开术中,使用自制切拨电刀治疗18例先天性肥厚性幽门狭窄患儿。切拨电刀采用扁状长头电刀,电刀头套上6号胃管,电刀头金属部分露出3mm,电凝模式切开幽门肌层,左右旋转使肌层分开,幽门分离钳进一步分离。结果18例患儿均顺利完成手术,未发生黏膜损伤,无中转开腹手术。手术时间13~40min,平均23min。手术后3~5d出院,平均时间3.8d。术后随访至3个月时,切口美观,无复发。结论自制切拨电刀制作简单、推广方便,操作灵活,可安全地应用于治疗先天性肥厚性幽门狭窄手术中,作为腹腔镜下幽门环肌切开术的有效工具之一。

Objective To summarize the application of specialized blade-shaped electrosurgical electrode (SBEE) during laparoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis (HPS). MethodsFrom March 2015 to June 2016, retrospective analysis of clinical data was performed for 18 children with congenital HPS treated with SBEE during laparoscopic pyloromyotomy.SBEE had a flat long head covered by 6 French nasogastric tube and fitted with a metal part exposed for 3 mm.Pyloric muscular layer was resected in an electric coagulation mode, separated by left and right rotations and further pyloric separation by using pliers.A seromuscular incision was performed over the avascular pyloric area with SBEE under an electric coagulation mode.Later SBEE was used for further splitting hypertrophied muscle down to submucosal layer.Then pyloric muscle was separated extensively by dissecting forceps. ResultsAll procedures were successfully completed under laparoscopy with SBEE without any conversion into laparotomy or mucosal damage.The average postoperative discharge time was 3.8 (3-5) days.During a follow-up period of 3 months, all incisions healed well without recurrence.The average operative duration was 23 (13-40) min and the average postoperative hospitalization stay 3.8 (3-5) days. ConclusionsSBEE is safe, simple and effective for congenital hypertrophic pyloric stenosis during laparoscopic pyloric myotomy.It offers more advantages than classical laparoscopy.