腹腔镜与经脐上小切口幽门环肌切开术治疗先天性肥厚性幽门狭窄的疗效比较

摘要

目的:对比分析腹腔镜幽门环肌切开术(laparoscopic pyloromyotomy,LP)与经脐上小切口幽门环肌切开术(open umbilical small incision pyloromyotomy,OP)治疗肥厚性幽门狭窄的临床疗效.方法:回顾分析2013年6月至2016年12月收治的43例肥厚性幽门狭窄患儿的临床资料,分为LP组(n=18)与OP组(n=25),比较两组手术时间、术后进食时间、住院时间、术后并发症等.结果:本组43例均痊愈;LP组术后无并发症发生;OP组2例发生切口裂开,1例出现应激性溃疡,两组并发症发生率差异无统计学意义(P=0.36).LP组手术时间[(27.12±4.91)min vs.(38.26±2.21)min]、术后饮水时间[(8.21±1.32)h vs.(12.01±1.03)h]、住院时间[(3.35±0.86)d vs.(6.15±1.22)d]优于OP组,差异有统计学意义(P<0.05).术后随访6～12个月,患儿生长发育良好,均无复发.结论:腹腔镜手术治疗小儿肥厚性幽门狭窄疗效确切、安全、可行,术中患儿创伤小,对周围脏器干扰小,术后康复快,值得临床推广.%Objective:To evaluate the efficacy and safety of laparoscopic pyloromyotomy ( LP ) and open umbilical small inci-sion pyloromyotomy (OP) for the treatment of congenital hypertrophic pyloric stenosis. Methods:The clinical data of 43 children who suffered from hypertrophic pyloric stenosis from Jun. 2013 to Dec. 2016 were retrospectively analyzed,and the patients were divided into LP group (n=18) and OP group (n=25). Their operation time,postoperative eating time,postoperative hospital stay and complications were analyzed. Results:All the 43 cases were well recovered,and there were no complications in the LP group while 2 cases of incision dehiscence and 1 case of stress ulcer in the OP group,which was not significantly different (P=0. 36). There were significant differ-ences in the operation time [(27. 12±4. 91) min vs. (38. 26±2. 21) min],the postoperative eating time [(8. 21±1. 32) h vs. (12. 01±1. 03) h] and the postoperative hospital stay [(3. 35±0. 86) d vs. (6. 15±1. 22) d] between the LP group and the OP group (P<0. 05). During a follow-up period of 6-12 months,all the children developed normally without recurrence. Conclusions:LP is effec-tive,safe and feasible for hypertrophic pyloric stenosis with mini-invasion,small disturbance to surrounding organs,quick recovery after operation,this procedure is worthy of clinical promotion.