超声在胃镜下幽门环肌切开术治疗先天性肥厚性幽门狭窄中的应用价值

Application value of ultrasound in the treatment of congenital hypertrophic pyloric stenosis by endoscopic sphincterotomy

目的应用超声观察行胃镜下幽门环肌切开术治疗先天性肥厚性幽门狭窄(CHPS)前后幽门管组织各层黏膜的改变,以及胃内液体通过幽门管的情况。方法对65例CHPS患儿行超声检查,观察其术前、术后1 d、术后1周、术后1个月和术后6个月幽门管各层黏膜厚度的改变,以及幽门管内径变化。经胃管向胃内注入浓稠奶液作为胃肠对比造影剂,观察造影剂通过幽门管的情况。结果 65例CHPS患儿术前肌层厚度为(4.85±0.82)mm,黏膜层及黏膜下层厚度为(2.14±0.33)mm,幽门管长径为(18.53±0.91)mm,幽门直径为(15.82±0.66)mm。经胃镜下幽门环肌切开术后1 d,黏膜及黏膜下层厚度与术前比较差异有统计学意义(P<0.05),余参数差异均无统计学意义;术后1周和术后1个月幽门管长径、直径、内径及幽门肌层厚度均较术前减小(均P<0.05),黏膜及黏膜下层厚度差异无统计学意义;术后6个月幽门管长径、直径、内径、幽门肌层厚度、黏膜及黏膜下层厚度均较术前减小(均P<0.05)。术后1周,38例患儿幽门呈现瞬时全开放状态;术后1个月,48例患儿幽门呈现瞬时全开放状态;术后6个月,56例患儿幽门可呈现瞬时全开放状态。结论超声在评估胃镜下幽门环肌切开术治疗CHPS后幽门肌层、黏膜及黏膜下层厚度变化及幽门管狭窄程度的改善方面有重要临床应用价值。

Objective To observe the gastric mucosa layers of pyloric canal stenosis tissue changes and liquid through the pyloric canal before and after endoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis（CHPS） by ultrasonography.Methods Sixty-five children with CHPS were examined by ultrasonography,the changes of the thickness of the mucosa of the pyloric tube and the diameter of the inner diameter of the pyloric tube were observed before the operation and 1 d,1 week,1 month and 6 months after the operation.The milk was injected into stomach through gastric tube as gastrointestinal contrast agent, the condition of the contrast agent passing through the pyloric tube was observed.Results The preoperative myometrial thickness of 65 children with CHPS was （4.85±0.82） mm,the thickness of mucosa and submucosa was （2.14±0.33） mm,the length and diameter of pylorus were （18.53±0.91） mm and （15.82±0.66） mm,respectively.Compared before the operation,the thickness of mucosa and submucosa 1 d after operation was significant difference（P〈0.05）,while there were no significant difference of remaining parameters.The length,diameter,internal diameter and thickness of pyloric muscular layer of pylorus decreased 1 week and 1 month after operation（all P〈0.05）.There were no significant difference in the thickness of mucosa and submucosa,but the length,diameter,internal diameter,muscularis thickness,mucosal and submucosal thickness of pyloric duct decreased 6 months after operation（all P〈0.05）.At 1 week after operation, 38 cases of pylorus showed transient full open state. At 1 month after operation, 48 cases of pylorus showed transient full open state. At 6 months after operation, 56 cases of pylorus showed transient full open state.Conclusion Ultrasound has important significance in evaluating the thinning of pyloric transient layer and mucosa and submucosa,as well as the improvement of the degree of pyloric stenosis before and after endoscopic pyloromyotomy in the treatment of CHPS.