腹腔镜治疗婴儿先天性肥厚性幽门狭窄39例报告

Laparoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis in infants:a report of 39 cases

目的总结腹腔镜幽门环肌切开术治疗婴儿先天性肥厚性幽门狭窄的临床经验及疗效。方法回顾性分析我科2016年1月-2018年12月收治的39例先天性肥厚性幽门狭窄患儿的临床资料,均行腹腔镜幽门环肌切开术。结果39例患儿中37例顺利于腹腔镜下完成手术,2例损伤幽门黏膜予中转开腹,2例术后进食后仍明显呕吐,行开腹手术后证实为幽门环肌切开厚度不够导致;1例术后半个月再次出现喷射性呕吐,行开腹手术后发现幽门管粘连右侧肝脏,考虑是蛋白胶凝固后粘连引起。手术时间15 min^40 min,平均25 min,术后6 h拔除胃管,开始喂养,术后2 d^6 d出院,平均3.5 d。术后随访7个月~42个月,平均22个月,均生长发育良好,无并发症发生。结论腹腔镜幽门环肌切开术治疗婴儿先天性肥厚性幽门狭窄创伤小、恢复快,值得推广。

Objective To explore the experience and efficacy of laparoscopic pyloromyotomy in the treatment of congenital hypertrophic pyloric stenosis in infants.Methods A retrospective analysis of 39 cases of congenital hypertrophic pyloric stenosis in our department from January 2016 to December 2018 was performed.All patients underwent laparoscopic pyloromyotomy.Results Among all 39 cases,37 cases underwent laparoscopic Pyloromyotomy without switching to laparotomy.2 cases of pyloric mucosa were injured and then operated by laparotomy,and 2 cases of postoperative were still vomiting after feeding,then underwent laparotomy and confirmed myotomy thickness were not enough.1 case of postoperative was vomiting half a month after operation half a month later.After laparotomy,the pyloric tube was found to be attached to the right liver,which was considered to be caused by adhesion of protein gel after coagulation.The operation time was 15~40 min,with an average of 25 min.The gastric tube was removed 6 hours after the operation,and the feeding was started.The patient was discharged 2~6 days after the operation,with an average of 3.5 days.The patients were followed up for 7~42 months,with an average of 22 months,and the growth and development were good without complications.Conclusions Laparoscopic pyloromyotomy for the treatment of congenital hypertrophic pyloric stenosis in infants with small trauma and rapid recovery,which is worthy of clinical promotion.