先天性肥厚性幽门狭窄的超声诊断

先生性肥厚性幽门狭窄(congential hypertrophic pyloricstenosis,CHPS)是新生儿常见多发的消化道畸形,临床主要表现为呕吐、胃蠕动波、右上腹包块三大症状。若不早期诊断及时手术,最后患儿常因严重营养不良而衰竭死亡;如能早期诊断及时手术,预后良好。以往诊断以X线钡餐检查为     

Infantile hypertrophic pyloric stenosis

Infantile hypertrophic pyloric stenosis (IHPS) is one of the most commonly encountered paediatric surgical conditions. It is estimated to affect between 1 and 4 infants per 1,000 births, representing the most common cause of surgical intervention in the first 6 months of life. The exact aetiology remains unclear. It is known to be more common in males (4:1), especially those that are first-born. Abdominal examination can sometimes detect visible stomach peristalsis in the left upper quadrant and the pathognomic sign of an “olive shaped” epigastric mass may be present. In cases of diagnostic uncertainty or where a definitive mass is not felt, ultrasound is the investigation of choice for confirming IHPS, with high sensitivity and specificity. Following appropriate pre-operative optimisation and surgical correction is undertaken. The Ramstedt's pyloromyotomy con be performed via a right upper quadrant, peri-umbilical, or laparoscopic approach. The vast majority of cases recover quickly with no concerns, with the infant almost invariably discharged soon after treatment. Perforation requiring mucosal repair and incomplete pyloromyotomy requiring re-do surgery as the specific complications.     

Infantile hypertrophic pyloric stenosis

Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants and is one of the most common conditions requiring surgery in the newborn. It arises from marked hypertrophy of the pyloric muscle (primarily circular layer), resulting in partial or complete luminal occlusion. Classically these infants have persistent non-bilious vomiting, are dehydrated with weight loss, and have a hypokalaemic, hypochloraemic metabolic alkalosis. Treatment requires initial careful fluid management before definitive surgical correction. Outcomes are now excellent in developed countries and long-term sequelae are not expected after treatment.     

Infantile hypertrophic pyloric stenosis

Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants and is one of the most common conditions requiring surgery in the newborn. It arises from marked hypertrophy of the pyloric muscle (primarily circular layer), resulting in partial or complete luminal occlusion. Classically these infants have persistent non-bilious vomiting, are dehydrated with weight loss, and have a hypokalaemic, hypochloraemic metabolic alkalosis. Treatment requires initial careful fluid management before definitive surgical correction. Outcomes are now excellent in developed countries and long-term sequelae are not expected after treatment.     

Ultrasonographic diagnosis criteria using scoring for hypertrophic pyloric stenosis

PURPOSE: For diagnosis of infantile hypertrophic pyloric stenosis (HPS), ultrasonography (US) is a useful and objective diagnostic method. In the current study, pyloric diameter, muscular thickness, and pyloric length were measured in normal infants (n = 26) and infants which is an adequate (n = 57). Each score was assigned to relevant measurements, and diagnostic criteria obtained with a scoring system were prepared using statistical skills by the probit analysis. METHODS: For scoring, points were given to relevant measurements in conformity with the probit analysis. Zero points were given to patients with no possibility of HPS, 1 point to those with less than 25% probability, 2 points to those with 25% or more but less than 50% probability, and 3 points to patients with 50% or more probability. Points were totaled, and analysis was performed. RESULTS: The composite score was evaluated by probit analysis, and cases with a composite score of 2 or less were all included in the normal group, whereas those with a composite score of 3 or more were all in the HPS group. Both groups could thereby be 100% identified. CONCLUSION: US was able to diagnose cases with overall score of 2 or less as normal and those with overall score of 3 or higher as having HPS. In addition, after the current diagnostic criteria were prepared, preoperative diagnoses were performed prospectively using them for vomiting neonates and infants, and all cases were correctly discriminated and diagnosed. These findings indicate our ultrasonographic diagnosis criteria are useful for diagnosing HPS.     

Adult hypertrophic pyloric stenosis.

Adult hypertrophic pyloric stenosis is an unusual disease of obscure etiology which causes varying degrees of gastric outlet obstruction. Diagnosis by history, physical examination, and roentgenography is difficult but can be readily made with fiberoptic gastroscopy where a characteristic pyloric "cervix sign" is seen. All of the many operations for relief of gastric outlet obstruction have been tried with this lesion, with resection and Billroth I reanastomosis the accepted treatment. Two patients are reported with adult hypertrophic pyloric stenosis who had typical endoscopic findings. One was treated with distal gastrectomy, and the other was adequately treated by endoscopic dilatation alone. It is suggested that endoscopic dilatation is acceptable as primary therapy in suitable cases.     

Immunohistochemical study of hypertrophic pyloric stenosis

In spite of the clinical experience about infantil Hypertrophic Pyloric Stenosis (IHPS), its etiopathology remains unknown. Recent studies have been focussed in immunohistochemistry techniques for valuing the neuronal development in the pyloric muscle.     

Torgersen's muscle and infantile hypertrophic pyloric stenosis

A child with recurrent vomiting following Ramstedt pyloromyotomy is presented. Section of the pyloric fibers of the left canalis loop of Torgersen resulted in prompt recovery. It is recommended that the muscle be identified and divided as part of routine pyloromyotomy in infantile hypertrophic pyloric stenosis.     

Peptidergic innervation in infantile hypertrophic pyloric stenosis

The gastrointestinal tract harbors several populations of peptide containing nerve fibers. Among the gut neuropeptides are vasoactive intestinal peptide (VIP), substance P, enkephalin, and gastrin releasing peptide (GRP). We have examined specimens from five patients with pyloric stenosis and from five controls immunocytochemically with respect to the density of nerve fibers containing VIP, substance P, enkephalin, or GRP. In the control specimens VIP and enkephalin fibers were fairly numerous, whereas substance P and GRP fibers were few. In the pyloric stenosis patients the density of VIP fibers and enkephalin fibers was reduced in the smooth muscle. In the myenteric ganglia there was no such reduction. Substance P and GRP fibers were rare as in controls. The results indicate a reduction of VIP and enkephalin fibers in smooth muscle in pyloric stenosis patients and may be interpreted to support the view that an impaired neuronal function is involved in the pathophysiology of pyloric stenosis.     

Balloon catheter dilatation for hypertrophic pyloric stenosis

Balloon dilating catheters (BDC) have provided a non-operative means of managing obstructive lesions within the gastrointestinal tract. Its potential utility in infants with hypertrophic pyloric stenosis (HPS) was studied. Six patients with HPS underwent balloon catheter dilatation of the pylorus under the direct observation of the surgeon. The pylorus was exposed using a standard right upper quadrant incision. The BDC was passed transorally into the stomach and manipulated into the pyloric canal by the surgeon. The balloon was inflated with saline to a maximum pressure of 50 psi for 2 minutes. Four patients were dilated with a 10-mm diameter balloon catheter, and in two patients, a 15-mm balloon was used. Success was defined as the complete and longitudinal disruption of the seromuscular ring without violation of mucosal integrity. Using this criterion, none had successful pyloric dilatation. No disruption occurred in three patients, partial disruption in two. These patients subsequently underwent a Ramstedt pyloromyotomy. Complete disruption was observed in one; however, a breach of the mucosa was evident. This was repaired without incident. All seromuscular breaks occurred at the point of vascular entry along the lesser curve, presumably the weakest point of the ring. Pyloric dilatation using BDC does not reliably disrupt the muscular ring. This preliminary report recognizes that major refinements must occur before this method will supplant the time-honored surgical pyloromyotomy for HPS.