早产儿肥厚性幽门狭窄的诊治

Diagnosis and Treatment of Hypertrophic Pyloric Stenosis in Preterm Infants

目的提高对早产儿肥厚性幽门狭窄(hypertrophic pyloric stenosis,HPS)诊治的认识。方法分析本院1例早产儿HPS的诊治,并查阅和复习国内外关于早产儿HPS文献。结果本例早产儿出生3周出现胃潴留量增加、呼吸暂停,出生6.5周出现喷射性呕吐。出生7周腹部X线检查示胃扩张,诊断HPS,行幽门环肌切开术,术后恢复良好顺利出院。随访至出生后6个月,体格发育逐渐追赶生长。近年文献报道早产儿HPS病例增加。按出生时间早产儿HPS发病晚于足月儿;按校正胎龄早产儿HPS发病则早于足月儿HPS。结论早产儿HPS早期症状不典型,可能表现为胃潴留量增加,以后出现呕吐,动态腹部影像学检查有助于诊断HPS。

Objective To improve the recognition of hypertrophic pyloric steaoSis （HPS） in preterm infants. Methods A case of preterm infant with HPS in our hospital was analyzed. Relevant literature was reviewed. Results The preterm infant with HPS presented increased gastric residual volume and recurrent apnea at 3 weeks of age and projectile vomiting at 6.5 weeks of age. Abdominal X-ray revealed gastric dilatation at 7 weeks of age and the infant was diagnosed as HPS. Py!oromyotomy was performed in the case and the infant recovered well after operation. Physical growth gradually adequated catch-up growth follow-up to 6 months after birth. Recent studies have found increased rates of HPS in preterm infants. The chronological age at presentation with HPS was later in preterm infants,but the postmenstrual age at presentation with HPS was earlier in preterm infants compared to full-term infants. Conclusion HPS in preterm infants presented with atypical clinical presentation at early stage and may presented with increased gastric residual volume. Vomiting may oceurr later. Repeat abdominal imaging examinations is helpful to diagnosis of HPS.