彩色多普勒超声在内镜下幽门括约肌切开术治疗先天性肥厚性幽门狭窄中的应用

目的:探讨彩色多普勒超声在一种新型手术疗法--内镜下幽门括约肌切开术治疗先天性肥厚性幽门狭窄(CHPS)中的应用.方法:行胃镜下幽门括约肌切开术的CHPS患儿20例,手术前后应用彩色多普勒超声观察正常组婴幼儿及CHPS组患儿术前肌层及黏膜层血流分级.现察CHPS患儿术前、术后1周、术后1个月肌层及黏膜层血流分级变化趋势.结果:正常纽婴幼儿与CHPS纽患儿肌层及黏膜层血流分级差异有明显统计学意义.CHPS组患儿术前与术后1周、术后1个月肌层及黏膜层血流分级无统计学意义.结论:彩色多普勒超声能很好地观察正常婴幼儿及CHPS患儿术前、术后肌层及黏膜层血流状况,对于诊断CHPS有较大的帮助.     

鼻饲泛影葡胺治疗术后早期炎症性肠梗阻34例的护理体会

总结34例鼻饲泛影葡胺治疗术后早期炎症性肠梗阻的护理.护理重点为做好胃肠减压护理,鼻饲泛影葡胺时注意注入速度,加强病情观察,重视营养支持.29例治疗后肠梗阻症状缓解,5例治疗无效中转手术.     

多普勒超声技术对胃镜下幽门肌切开术治疗先天性肥厚性幽门狭窄疗效的评估

目的 探讨多普勒超声技术评估胃镜下幽门肌切开术治疗先天性肥厚性幽门狭窄（CHPS）疗效的临床价值。方法 应用多普勒超声对65例确诊为CHPS患儿及50例对照组婴儿的幽门进行检测,比较其幽门肌层及黏膜层的厚度及血流分级。观察并比较CHPS患儿术前和胃镜下幽门肌切开术术后1 d、1周、1个月及6个月时幽门管各层组织的血流分布及血流参数的变化,同时观察造影剂通过幽门管情况及幽门管内径变化情况。结果 CHPS组与对照组的肌层及黏膜层厚度,肌层及黏膜层血流分级均具有显著统计学意义（均P＜0.01）。CHPS组与术前比较,术后1 d黏膜层血流更丰富;术后1周及1个月幽门管内径增宽,肌层变薄,术后6个月肌层厚度进一步变薄,肌层、黏膜层血流较术前稀疏减少,肌层Vmax减慢,RI减小。结论 　通过彩色多普勒超声可观察胃镜下幽门切开术后幽门管各层组织血流变化规律,并可通过测量Vmax及RI以协助估计幽门狭窄的程度和手术疗效评估。     

食管癌术后吻合口瘘的影像学诊断

目的分析食管癌术后吻合口瘘的影像学特点,提高早期诊断方法。方法对56例临床高度怀疑食管癌术后吻合口瘘的患者,口服泛影葡胺(60%)或者稀硫酸钡(100%W/V),在X线胃肠机上多体位透视并适时点片。对用上述方法未发现吻合口瘘的病例,再口服泛影葡胺40～60 ml后,行CT吻合口层面动态扫描。结果 56例口服泛影葡胺造影检查,发现吻合口瘘14例;42例口服稀硫酸钡造影检查,发现均首先吻合口瘘3例;39例口服泛影葡胺后CT动态扫描,发现食管吻合口瘘4例。结论食管癌术后口服泛影葡胺(60%)造影检查,多数能够发现瘘口,口服稀硫酸钡(100%W/V)检查和吻合口层面CT动态扫描能够进一步发现吻合口瘘。     

超声检查在婴儿先天性肥厚性幽门狭窄中运用的临床探讨

先天性肥厚性幽门狭窄（Congenital hypertrophicpyloricstenosis,CHPS）是新生儿期常见的外科疾病,患儿因幽门部肌肉肥厚、增生,造成腔道狭窄而导致幽门部机械眭梗阻,CHPS发病率约占消化道畸形的第三位。若能对CHPS患儿进行早期诊断并进行早期治疗,则患儿的预后良好;否则可导致患儿营养不良,甚至出现死亡。随着高频超声对婴儿CHPS检查技术的提高,实现了对婴儿CHPS的早期无创性诊断。作者对超声与x线造影检查在婴儿CHPS临床诊断中的结果进行比较,旨在探讨最适合婴儿CHPS临床诊断的影像学检查方法,现报告如下。     

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

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(P0.05),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P0.05),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P0.05)。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。     

高频超声在胃镜下幽门肌切开术治疗CHPS的应用价值

目的　旨在通过运用高频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)前后肥厚狭窄的幽门管组织各层粘膜改变以及胃内液体通过幽门管情况,以探讨高频超声在此新型微创术式的应用价值和临床意义。方法　对65例CHPS的患儿进行超声检查,观察CHPS患儿术前与术后1天、术后1周、术后1个月、术后6个月幽门管各粘膜层厚度的改变以及幽门管内径变化。结果　手术后1天黏膜及黏膜下层厚度较手术前增加;术后1周及术后1个月幽门管长径、直径、幽门肌层厚度较手术前减小,黏膜及黏膜下层厚度无变化;手术后6个月幽门管长径、直径、幽门肌层厚度、黏膜及黏膜下层厚度均较手术前减少。术后胃内液体通过幽门管的次数较术前明显增多,幽门管开放程度增大。结论　根据高频超声所测得的胃镜下幽门肌切开术治疗CHPS前后的数据发现,幽门肌层和黏膜及黏膜下层厚度的变薄以及幽门管的狭窄程度改善,得出该微创术式是有效的手术方法,超声对其手术的疗效评估有重要的意义。     

泛影葡胺胶浆经纤维支气管镜选择性支气管造影20例临床分析

目的探讨选用泛影葡胺胶浆经纤维支气管镜选择性支气管造影的方法、安全性、临床效果、并发症。方法对20例经胸部X线片、常规CT、HRCT等检查需外科手术治疗的支气管扩张患者选用泛影葡胺胶浆经纤维支气管镜选择性支气管造影检查;分别测定术前、术中、术后4h动脉血气分析及动态监测SaO2;术后观察咳嗽、呼吸、发热;外科手术后取病理检查泛影葡胺胶浆的残留。结果该操作方法简单易行;术中与术前比较PaO2及SaO2有下降,差异有显著性(P<0.001),但术中SaO2(95.55%±1.43%)大于90%以上,平均操作时间短(7.6±1.39)min,患者能耐受;术后4h与术前比较PaO2及SaO2差异无显著性(P>0.05);该组资料肺叶、肺段、亚段支气管及分支全部显影,显影率100%(20/20);外科手术后取病理检查未见泛影葡胺胶浆的残留。结论选用泛影葡胺胶浆经纤维支气管镜选择性支气管造影的方法具有操作简单易行、操作时间短、患者能耐受、安全性好、成功率高、显影图像清晰、无造影剂残留、并发症少以及能为手术肺叶切除提供准确的范围等优点,值得临床推广应用。     

静脉尿路造影推注泛影葡胺的护理体会

目的探讨静脉尿路造影中的观察及护理要点。方法对100例患者推注泛影葡胺行静脉静脉尿路造影检查及诊断。结果本组除6例因推注泛影葡胺5～6ml时出现剧烈呕吐,立即停止推注药液未显影外,其余均顺利完成检查,并显影良好。结论静脉尿路造影推注泛影葡胺具有一定的危险性,但对确定泌尿系阴性结石占有一定指导意义。因此检查时和检查中均应密切观察碘过敏反应是非常重要的。     

先天性肥厚性幽门狭窄的影像学诊断

先天性肥厚性幽门狭窄(CHPS)是新生儿期常见的疾病;患儿呕吐频繁,摄入量不足可造成慢性脱水、电解质紊乱和营养不良,及时诊断,手术治疗可痊愈.本文搜集78例持续性呕吐疑诊CHPS患儿,观察CHPS的彩色多普勒超声和钡餐造影的影像表现,以提高对本病的认识.     

高频超声诊断婴幼儿先天性肥厚性幽门狭窄的应用价值

目的:探讨高频超声在诊断婴幼儿先天性肥厚性幽门狭窄(C H P S)的临床应用价值.方法:回顾性分析我院收治的11例怀疑先天性肥厚性幽门狭窄患儿的超声表现,观察胃潴留情况、胃内容物通过幽门管情况、幽门管形态,测量幽门肌层厚度、幽门管直径、幽门管长度.结果:11例患儿均为足月儿,均为进行性呕吐加重,1例经内科治疗后好转,...     

高频超声与X线钡剂造影对先天性肥厚性幽门狭窄诊断及分型的价值

目的 探讨高频超声与X线钡剂造影对先天性肥厚性幽门狭窄(CHPS)诊断与分型诊断的价值.方法 对以呕吐为主要症状的患儿常规进行高频超声和X线钡剂造影检查,并将两种检查方法加以对照.对经手术证实、资料完整的29例病例进行回顾性分析.正常组选取健康新生儿20例,并对其正常测值与CHPS组进行对比.结果 29例CHPS,超声诊断符合率100%,X线诊断符合率93.1%(27/29).CHPS组超声测量幽门管的长度均≥18 mm,幽门管直径≥14 mm,幽门管壁厚度≥4 mm,狭窄的管腔径均≤6 mm;X线测量幽门管长≥20 mm,管腔径≤7 mm,与正常组比较差异均有统计学意义(P＜0.01).根据幽门管腔狭窄和管壁增厚程度的影像表现,将CHPS分为轻型(Ⅰ)和重型(Ⅱ)两类,若4 mm≤幽门管壁厚≤6 mm,幽门管腔径＞3 mm为轻型;幽门管壁厚＞6 mm,幽门管腔径≤3 mm或呈闭塞状为重型.结论 CHPS的超声分型诊断具有一定的临床价值;高频超声对CHPS的诊断简便易行、准确可靠,避免了患儿吞钡和X线照射及减少吸人性肺炎的危险.     

高频超声在婴幼儿先天性肥厚性幽门狭窄诊断中的应用

目的探讨高频超声在先天性肥厚性幽门狭窄（ＣＨＰＳ）中的应用价值。方法对３０例ＣＨＰＳ患儿的幽门管长度、厚度及幽门肌层厚度进行测量,并与手术结果及１０例正常婴儿进行比较。结果超声测量ＣＨＰＳ幽门管长度≥１５ｍｍ,幽门管厚度≥１０ｍｍ,幽门肌层厚度≥４ｍｍ,与正常婴儿比较均有显著性差异（Ｐ〈０．０１）,超声测量ＣＨＰＳ患儿幽门管厚度和幽门肌层厚度与手术中测量无显著性差异（Ｐ〉０．０５）。结论高频超声对     

先天性肥厚性幽门梗阻合并先天性喉软骨发育不良患儿手术的麻醉管理

目的 探讨先天性肥厚性幽门梗阻(CHPS)合并先天性喉软骨发育不良患儿手术的麻醉管理方法,为易发生呼吸道塌陷患儿的麻醉管理提供参考.方法 选择2016年3月15日,于四川大学华西医院儿外科收治的1例CHPS合并喉软骨发育不良患儿作为研究对象.对其采取喉面罩通气道(LMA)全身麻醉复合超声引导下骶管阻滞麻醉,并拟对其进行腹腔镜下幽门环肌切开术治疗.由于考虑腹腔镜的气腹压力,可增加胃内容物反流误吸的风险,故修改手术方案为开腹幽门环肌切开术.回顾性分析本例患儿的临床特征及开腹幽门环肌切开术麻醉管理经过.结果 本例患儿的麻醉效果满意,顺利完成开腹幽门环肌切开术.手术结束10 min后,患儿清醒,遂拔除LMA导气管,无不良事件发生.患儿术后于重症监护病房(ICU)接受治疗期间,无呼吸道问题发生,术后7d出院.术后1年电话随访,其父诉患儿喉鸣症状于患儿6个月龄左右时逐渐消失,患儿生长发育良好.结论 LMA全身麻醉复合超声引导下骶管阻滞麻醉,可以满足本例CHPS合并先天性喉软骨发育不良患儿的手术麻醉需求,并减少其呼吸道不良事件的发生.     

Does dehydration affect thickness of the pyloric muscle? An experimental study

Congenital hypertrophic pyloric stenosis (CHPS) is a common condition in infancy associated with smooth muscle hypertrophy and resulting in pyloric outlet obstruction. The final diagnosis of CHPS is based on precise ultrasonographic measurements of length and width of the pyloric muscle. Based on our clinical and sonographic experience, we observed that smaller measurements of the pyloric muscle were obtained in dehydrated infants than in children examined after proper fluid restoration. The clinical importance of these observations was evident because false-negative results could be obtained. An experimental animal work followed, proving our clinical observation to be true. A significant difference of about 30% to 50% was found between measurements of the muscle thickness of the gastric and pyloric muscles in a state of water deprivation, as compared with a state of full hydration (p < 0.05). Based on our preliminary results, we suggest that children with suspected CHPS should be well hydrated before the ultrasound (US) examination is performed, to avoid false-negative results and a consequent delay in treatment.     

A randomised, prospective study comparing two contrast media in ERCP

A randomised, prospective, stratified, double blind study comparing two contrast media in endoscopic retrograde cholangio-pancreatography (ERCP) was undertaken. Forty-six patients received Meglumine/Sodium Ioxaglate (Hexabrix 320) and forty-eight received Meglumine/Sodium Diatrizoate (Urografin 310). The two groups were evenly matched for age, sex and diagnosis. Radiographs were examined independently by two radiologists. There were no differences in radiograph quality with either type of contrast medium. More patients developed pancreatitis following Urografin, suggesting that Hexabrix is a safer contrast medium for ERCP.     

Ultrasound follow-up of infantile hypertrophic pyloric stenosis (IHPS) during conservative therapy: ultrasound findings as criteria for diagnosis and cure

Purpose  During conservative therapy of infantile hypertrophic pyloric stenosis (IHPS) with atropine sulfate, there are many patients who do not achieve normal values of pyloric wall thickness and canal length even though they are clinically cured (vomiting has ceased); an objective criterion for cure has not yet been established. The aim of this study was to examine whether the appearance of pyloric wall stratification can be used as a criterion for cure. Methods  Twenty infants with IHPS who were treated conservatively were enrolled. Two of them ultimately required surgery. Ultrasound examinations were done serially and the pyloric wall thickness and canal length were measured. The echogenicity of the pyloric wall and the presence of wall stratification were noted. Results  On admission, all infants satisfied the ultrasound criteria for IHPS and had a heterogeneous pyloric wall without stratification. With conservative therapy, symptoms disappeared, the pyloric wall thickness and the canal length gradually decreased, the echogenicity gradually became homogeneous and hypoechoic, and wall stratification appeared (in most cases before the pyloric wall thickness and the canal length had normalized). The absence of wall stratification suggests that cellular interstitial changes, such as edema or inflammation, are present in the pyloric wall in the acute stage. Conclusion  Pyloric wall stratification was absent during the acute stage, but it appeared after initiation of treatment but before the pyloric wall thickness and the canal length had normalized. The presence of pyloric wall stratification can be used as a criterion for cure; the absence of wall stratification can be added to ultrasound diagnostic criteria for IHPS.     

腹腔镜手术治疗新生儿先天性肥厚性幽门狭窄的安全性与有效性

【目的】探讨腹腔镜手术治疗新生儿先天性肥厚性幽门狭窄的安全性及有效性。【方法】根据手术方式的不同将88例先天性肥厚性幽门狭窄新生儿分为腹腔镜手术的观察组和开腹手术的对照组,每组各44例,比较两组患儿的治疗效果及并发症情况。【结果】两组患儿的手术时间、术后进全奶时间、住院费用以及并发症发生率和术后呕吐发生率比较,差异均无统计学意义(P >0.05)。观察组患儿的住院时间及切口瘢痕长度均显著短于对照组,差异具有统计学意义(P <0.05)。【结论】腹腔镜手术治疗新生儿先天性肥厚性幽门狭窄,不仅能获得与开腹手术相当的疗效,还具有切口小、机体损伤轻、术后恢复快等优点。     

婴幼儿先天性肥厚性幽门狭窄超声与X 线诊断的对比研究

目的　通过超声诊断CHPS 3 1例 ,与X线对照 ,讨论超声诊断的临床意义。方法　对X线诊断为CHPS的患儿进行超声检查 ,测量幽门管肌层厚度 ,观察胃潴留情况。结果　超声测量幽门横切面 ,幽门肌厚度≥ 3 .5mm ,合并胃潴留的3 1例患儿 ,诊断为CHPS ,与X线诊断相符合 ,并经手术证实。结论　超声可作为CHPS诊断的首选方法。