先天性肥厚性幽门狭窄的治疗策略

Treatment strategies for congenital hypertrophic pyloric stenosis

目的探讨先天性肥厚性幽门狭窄（CHPS）治疗方法的选择。方法2010年4月至2014年9月我院共收治52例CHPS患儿，其中27例采取阿托品序贯疗法（序贯组）治疗，25例采取腹腔镜手术（手术组）治疗。比较两组患儿呕吐缓解率、并发症、住院天数和治疗费用。随访6个月，观察两组患儿体质量和幽门肌的改变。结果呕吐缓解率序贯组88．9%（24／27），手术组100％（25／25）。两组患儿均无严重并发症。序贯组治疗费用显著低于手术组（P〈0．01），但住院天数长于手术组（P〈0．01），差异有统计学意义。两组患儿体质量和幽门肌厚度对比，差异无统计学意义（P〉0．05）。结论阿托品序贯疗法有效、安全、经济，可作为无创治疗供临床选择。

Objective To evaluate the treatment strategies for congenital hypertrophic pyloric stenosis （CHPS）. Methods A total of 52 CHPS patients were treated during April 2010 to September 2014 at our hospital. Twenty-seven cases received sequential atropine therapy （ST group） while another 25 cases underwent laparoscopy （operation group）. The relief rates of vomiting, complications, hospital stay and medical expenditure were compared between two groups. After a follow-up period of 6 months, the weight and thickness of pyloric muscle were observed in two groups. Results The relief rate was 88.9% （24/27） in ST group and 100% （25/25） in operation group. No severe complications occurred in neither groups. As compared with control group, the hospital stay was significantly longer while medical expenditure was significantly lower in ST group. No statistically significant inter-group difference existed in the changes of body weight and pylorie muscle thickness. Conclusions Atropine sequential therapy is safe, effective and economical. And it may be used as a noninvasive alternative for CHPS.