经脐单一部位腹腔镜手术治疗小儿先天性肥厚性幽门狭窄30例

摘要

Objective To investigate the clinical efficacy of transumbilical single-site laparoscopic pyloromyotomy for treating congenital hypertrophic pyloric stenosis ( CHPS). Methods From August 2012 to December 2013, transumbilical single-site laparoscopic pyloromyotomy was applied in 30 cases of CHPS .The procedure was performed by using a 5 mm trocar in the navel for the laparoscope and two 3 mm trocars in the right side of umbilical ring crease .Through these 3 mm trocars, a hook electrode, a non-traumatic grasping forceps , and a dissecting forceps were in turn utilized to carry out pyloromyotomy . Results All the 30 patients underwent laparoscopic pyloromyotomy successfully without conversion to open operations .The duration of operation was 25-55 min (35.9 ±12.1 min).The nasogastric tube was removed about 6 hours after operation, and oral feeding was given gradually from water to full milk.On the 3-6 d (3.75 ±1.12 d) after operation, the patients were discharged without postoperative complications . The incisional scars had satisfying appearance .Follow-up scheduled for 3 -6 months showed that all the patients were normally developed .Umbilical scar was hardly observed . Conclusion Transumbilical single-site laparoscopic pyloromyotomy is a safe and reliable procedure , with good cosmetic outcomes .%目的：探讨经脐单一部位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（ congenital hypertrophic pyloric stenosis， CHPS）的临床疗效。方法2012年8月～2013年12月，我科应用腹腔镜经脐单一部位行幽门环肌切开术治疗小儿先天性肥厚性幽门狭窄30例。术中在脐部置入5 mm trocar，放置腹腔镜，在脐环皱褶旁右侧放置2个3 mm trocar，先后置入电钩、抓钳和幽门分离器，完成幽门环肌切开术。结果30例手术顺利完成，无中转开腹。手术时间25～55 min，（35．9±12．1）min。无并发症发生。术后6 h拔除胃管，从喂糖水逐渐过渡至喂奶。术后住院3～6 d，（3．8±1．1）d。切口隐蔽且美观。30例术后随访3～6个月，生长发育均恢复正常，脐部外观美观，几乎无法观察到手术瘢痕。结论经脐一单部位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安全可靠，疗效满意，切口隐蔽且美观。