腹腔镜下幽门环肌切开术与经脐上小切口幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄的效果比较

Comparison on the Effects of Laparoscopic Pyloromyotomy and Transumbilical Small-Incision Pyloromyotomy in the Treatment of Congenital Hypertrophic Pyloric Stenosis in Neonates

目的分析腹腔镜下幽门环肌切开术与经脐上小切口幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄(CHPS)的效果。方法82例CHPS患儿根据治疗方法的不同分为两组,参照组接受经脐上小切口幽门环肌切开术治疗,研究组接受腹腔镜下幽门环肌切开术治疗,比较两组的围术期指标、疼痛程度、并发症。结果研究组的术中出血量少于参照组,术后恢复喂养时间及住院时间均短于参照组,术后48 h的CRIES评分低于参照组(P<0.05)。两组的手术时间、术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论与经脐上小切口幽门环肌切开术相比,腹腔镜下幽门环肌切开术治疗小儿CHPS的创伤较小,可明显减轻患儿的术后疼痛程度,加快患儿术后恢复,且未明显增加术后并发症发生风险。

Objective To analyze the effects of laparoscopic pyloromyotomy and transumbilical small-incision pyloromyotomy in the treatment of congenital hypertrophic pyloric stenosis in neonates.Methods According to different treatment methods,82 neonates with CHPS were divided into two groups.The reference group received transumbilical small-incision pyloromyotomy,and the study group received laparoscopic pyloromyotomy.The perioperative indicators,pain degree and complications were compared between the two groups.Results The intraoperative blood loss amount of the study group was less than that of the reference group,the time for resuming feeding after surgery and the hospitalization time were shorter than those of the reference group,and the CRIES score at 48 h after surgery was lower than that of the reference group(P<0.05).No significant difference was found in the operation time and the total incidence of postoperative complications between the two groups(P>0.05).Conclusions Compared with transumbilical small-incision pyloromyotomy,laparoscopic pyloromyotomy has less trauma in the treatment of CHPS in neonates,which can significantly relieve the postoperative pain degree and accelerate the postoperative recovery of neonates,without significant increase of the occurrence risk of postoperative complications.