腹腔镜与开放手术治疗肥厚性幽门狭窄的效果比较

The comparative study of laparoscopic and open surgery in treatment of hypertrophic pyloric stenosis

目的比较腹腔镜幽门环肌切开术和开放手术治疗肥厚性幽门狭窄(HPS)的效果。方法回顾性分析2015年7月至2019年12月中国科学技术大学附属第一医院(安徽省立医院)儿外科收拾的65例HPS患儿的临床资料,根据手术方式的不同,分为腹腔镜组(n=37)与开放手术组(n=28)。评估两组患儿手术效果及预后,并比较两组患儿术中出血、手术时间、总住院时间、术后住院时间及并发症情况的差异;根据患儿术前是否输液治疗,分为输液组(n=14)与未输液组(n=50),分析比较两组患儿实验室指标的差异。结果65例患儿均获得成功,无复发病例,2例腹腔镜患者中转开腹手术(1例因黏膜破损,1例因腹腔肠管胀气操作空间不足)。腹腔镜组患儿总住院时间为(9.73±3.24)d,手术后住院时间为(5.81±1.97)d,均低于开放组,差异有统计学意义(P<0.05);输液组患儿血清钠水平为(137.54±2.67)mmol/L,氯为(98.76±5.39)mmol/L,渗透压为(271.67±5.33)mmol/L,均高于未输液组,差异有统计学意义(P<0.05)。结论2种手术方式治疗HPS均安全有效,而腹腔镜幽门环肌切开术能减少总住院时间,术后康复更快;对HPS患者尽早进行液体复苏有利于纠正电解质紊乱。

Objective To compare the clinical efficacy of laparoscopic pyloromyotomy and open surgery in the treatment of hypertrophic pyloric stenosis(HPS).Methods The clinical data of 65 patients with hypertrophic pyloric stenosis in the Department of Pediatrics,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from July 2015 to December 2019 were retrospectively analyzed.The clinical data were statistically described and analyzed.According to the operation method,the patients were divided into laparoscopic group(n=37)and open surgery group(n=28).According to whether the children were treated with infusion before operation,they were divided into the infusion group(n=14)and the non-infusion group(n=50),and the differences in the laboratory resources of the two groups were analyzed and compared.The operation effect and prognosis of the two groups were evaluated,and the differences inintraoperative bleeding,operation time,total hospitalization time,postoperative hospital stay and complications between the two groups were compared.According to whether the children were treated with infusion before operation,they were divided into infusion group(n=14)and non-infusion group(n=50),and the differences in laboratory parameters between the two groups were analyzed and compared.Results All cases were successful;there were no recurrence cases,two cases of laparoscopic conversion to open(1 case due to mucosal damage,and 1 case had insufficient operation space due to abdominal distension).The total hospitalization time of laparoscopic group was(9.73±3.24)days and postoperative hospital stay was(5.81±1.97)days,which were lower than those of open group(P<0.05).The serum Na(137.54±2.67)mmol/L,Cl(98.76±5.39)mmol/L and osmotic pressure(271.67±5.33)mmol/L in infusion group were significantly higher than those in non-infusion group(P<0.05).Conclusions The two surgical methods are safe and effective for the treatment of HPS.Laparoscopic pyloromyotomy can reduce the total length of hospital stay and achieve quicker recovery after operation.Early fluid resuscitation for patients with HPS is helpful to correct electrolyte disorder.