腹腔镜下幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄50例报告

目的总结腹腔镜下幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄的成功经验.方法2001年4月～2004年4月,应用腹腔镜下幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄50例,年龄12～90 d,平均35 d.分别在左、右上腹各置入3 mm trocar,左侧trocar置入无损伤抓钳夹近幽门处胃壁,右侧trocar先后置入伸缩式幽门肌切开刀、剥离器和幽门分离钳,完成幽门环肌切开术.结果腹腔镜下完成手术48例,中转开腹2例,其中1例为术中发现幽门前瓣膜症,1例为幽门黏膜损伤,经开腹修补痊愈.手术时间15～45 min,平均25 min.术后6 h拔胃管,开始喂奶.3～5 d出院.42例术后随访3～6个月,平均4.5月,生长发育均恢复正常.结论丰富的开腹手术经验、熟练的腹腔镜操作技术、术中良好的麻醉和合适的手术器械是完成腹腔镜下幽门环肌切开术的保障.

Laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis: A report of 50 cases

Objective To summarize the experience of l ap aroscopic pyloromyotomy for the treatment of infantile hypertrophic pyloric sten osis (IHPS). Methods Laparoscopic pyloromyotomy was employed i n 50 cases of IHPS from April 2001 to April 2004. The patients aged 12~90 days ( mean, 35 days). Three 3-mm-diameter trocars were introduced into the abdominal c avity via the left, right and upper abdominal wall, respectively. A non-traumati c grasping forceps was inserted through the left trocar to manipulate the gastri c wall near the pylorus. Through the right trocar, a retractable pyloromyotomy s calpel, a stripper and a dissecting forceps were in turn utilized to complete py loromyotomy. Results The operation was completed under laparos cope in 48 cases, while a conversion to open surgery was needed in 2 cases (1 c ase of prepyloric membrane and 1 case of pyloric mucosal injury, which were cure d by open repair). The operative time was 15~45 min (mean, 25 min). The nasogast ric tube was removed and oral feeding with milk was attempted 6 hours after the operation. The patients were discharged at 3~5 postoperative days. Follow-up for 3~6 months (mean, 4.5 months) in 42 cases showed that the patients were normall y developed. Conclusions Laparoscopic pyloromyotomy can be wel l performed in the presence of experience in open surgery, technical skills in l aparoscopy, effective anesthesia and proper surgical instruments.