先天性肥厚性幽门狭窄死亡原因分析

Analysis of the death cause in congenital hypertrophic pyloric stenosis

目的分析先天性肥厚性幽门狭窄的死亡原因以提高患儿存活率。方法对626例先天性肥厚性幽门狭窄患儿病例进行分析,其中治愈602例,未手术出院20例,死亡4例,治愈率达96.16%。分析死亡病历的临床特点及死亡原因。结果 4例死亡病例均发生在术后。2例不耐受手术打击出现心肺功能衰竭死亡。1例术后死于高血钾。1例术后手术创面活动性出血,经保守治疗时出现猝死。结论先天性肥厚性幽门狭窄主要死亡原因是重症感染、内环境代谢紊乱、术后应激反应、喂养不当,重视预防、积极处理可降低危重病患儿的病死率。术前感染控制、电解质紊乱的纠正、营养的改善以及术中、术后等围手术期仔细、全面的治疗、预防应激反应是患儿顺利恢复的关键。

Objective To analyze the data of the death cause in congenital hypertrophic pyloric stenosis in order to improve the survival rate.Methods Totally 626 patients diagnosed with HPS were analyzed,602 cases underwent laparoscopic pyloromyotomy and cured,20 cases were discharged from hospital without operation,and 4 cases died,the cure rate being 96.16%.For the 4 death cases,we analyzed the clinical characteristics and causes of death.Results The 4 deaths occurred after operation：2 cases died after operation because of cardiorespiratory function failure,and 1 case died from hyperkalemia.The surgical wound bleeding occurred in 1 patient after operation,and there was a sudden death in the treatment.Conclusion The main causes of death of HPS are severe infection,internal metabolic disorders,stress reaction after operation,and improper feeding.Paying high attention to the prevention and managing actively can reduce the fatality.The key to successful recovery is the control of infection,electrolyte disturbance correction,and improved nutrition in preoperative period,and careful and comprehensive treatment and prevention of stress reaction during and after operation.