腹腔镜与开腹幽门环肌切开术治疗先天性肥厚性幽门狭窄疗效比较

摘要

目的 比较腹腔镜与开腹幽门环肌切开术治疗先天性肥厚性幽门狭窄(CHPS)的临床疗效.方法 选取2010年3月至2016年7月漯河市第二人民医院收治的CHPS患儿63例,根据治疗方法将患儿分为腹腔镜手术组(n=31)和开腹手术组(n=32),腹腔镜手术组患儿行腹腔镜幽门环肌切开术,开腹手术组患儿行开腹幽门环肌切开术,对2组患儿的手术时间、术中出血量、术后恢复喂养时间、住院时间、并发症、胃内压及食管下端括约肌压(LESP)进行比较.结果 2组患儿手术时间比较差异无统计学意义(t=0.277,P＞0.05);腹腔镜手术组患儿术后住院时间及恢复喂养时间显著短于开腹手术组(t=14.302、17.935,P＜0.05),术中出血量显著少于开腹手术组(t=13.064,P＜0.05).术前2组患儿的胃内压、LESP比较差异均无统计学意义(t=0.316、0.529,P＞0.05),2组患儿术后胃内压显著低于术前(t=10.613、9.851,P＜0.05),2组患儿术后LESP与术前比较差异均无统计学意义(=2.643、2.772,P ＞0.05),术后2组患儿的胃内压、LESP比较差异均无统计学意义(t=0.237、0.329,P＞0.05).开腹手术组和腹腔镜手术组患儿术后并发症发生率分别为15.63％(5/32)、3.23％(1/31),腹腔镜手术组患儿并发症发生率显著低于开腹手术组(x2=3.991,P＜0.05).结论 腹腔镜下幽门环肌切开术治疗CHPS可以有效解除幽门狭窄,且具有创伤小、患儿术后恢复快、并发症少等特点.%Objective To compare the clinical effect between laparotomy and laparoscopic pyloromyotomy in the treatment of congenital hypertrophic pyloric stenosis (CHPS).Methods Sixty-three children with CHPS were selected from March 2010 to July 2016 in the Second People's Hospital of Luohe City.The children were divided into laparoscopic operation group (n =31) and laparotomy group (n =32) according to the treatment methods.The children in the laparoscopic operation group were treated with laparoscopic pyloromyotomy,and the children in the laparotomy group were treated with laparotomy.The operation time,intraoperative blood loss,postoperative recovery feeding time,hospitalization time,complications,intragastric pressure and lower esophageal sphincter pressure (LESP) were compared between the two groups.Results There was no significant difference in operation time between the two groups (t =0.277,P ＞ 0.05).The postoperative hospitalization time and recovery feeding time in the laparoscopic operation group were significantly shorter than those in the laparotomy group (t =14.302,17.935;P ＜0.05),and the intraoperative blood loss in the laparoscopic operation group was significantly less than that in the laparotomy group (t =13.064,P ＜ 0.05).There was no significant difference in the intragastric pressure and LESP between the two groups before operation (t =0.316,0.529;P ＞ 0.05).The intragastric pressure after operation was significantly lower than that before operation in the two groups (t =10.613,9.851;P ＜0.05).There was no significant difference in LESP before and after operation in the two groups (t =2.643,2.772;P ＞ 0.05).There was no significant difference in the intragastric pressure and LESP between the two groups after operation (t =0.237,0.329;P ＞ 0.05).The incidence of postoperative complications in the laparotomy group and laparoscopic operation group was 15.63％ (5/32) and 3.23％ (1/31) respectively,the incidence of complications in laparoscopic operation group was significantly lower than that in laparotomy group (x2 =3.991,P ＜ 0.05).Conclusion laparoscopic pyloromyotomy can effectively relieve pyloric stenosis in the treatment of CHPS,and it has the characteristics of small trauma,quick recovery and less complications.