CAJ | 학술논문

目的比较腹壁牵引法与CO2气腹法两种幽门环肌切开术的优缺点,探讨腹壁牵引法幽门环肌切开术的应用价值.方法回顾分析2006年3月至2007年9月,我院普外科收治先天性肥厚性幽门狭窄病例66例,其中21例行腹壁牵引法腹腔镜幽门环肌切开术,45例行CO2气腹法腹腔镜幽门环肌切开术,比较两组患儿术中血气分析及生命体征监测的各项指标、术后并发症、住院时间及治疗费用.结果 CO2气腹法组气腹10 min后,pH值、PCO2、HCO3-浓度较气腹前变化明显,差异有统计学意义(P<0.05),MBP、HR较术前有升高,但差异尤统计学意义(P0.05),SPO2改变不明显.腹壁牵引法组在Veress针穿刺10 min后各个指标较术前均无明显变化.两组比较手术用时及术后偶发呕吐比例差异无统计学意义(P0.05),术后进食时间、术后呼吸道感染发生比例、住院天数、治疗费用差异均有统计学意义(P<0.05).结论腹壁牵引法腹腔镜幽门环肌切开术较传统气腹法腹腔镜手术更简便、经济,并发症相对少,有一定的应用价值.
목적 비교복벽견인법여CO2기복법량충유문배기절개술적우결점,탐토복벽견인법유문배기절개술적응용개치.방법 회고분석2006년3월지2007년9월,아원보외과수치선천성비후성유문협착병례66례,기중21례행복벽견인법복강경유문배기절개술,45례행CO2기복법복강경유문배기절개술,비교량조환인술중혈기분석급생명체정감측적각항지표、술후병발증、주원시간급치료비용.결과 CO2기복법조기복10 min후,pH치、PCO2、HCO3-농도교기복전변화명현,차이유통계학의의(P<0.05),MBP、HR교술전유승고,단차이우통계학의의(P0.05),SPO2개변불명현.복벽견인법조재Veress침천자10 min후각개지표교술전균무명현변화.량조비교수술용시급술후우발구토비례차이무통계학의의(P0.05),술후진식시간、술후호흡도감염발생비례、주원천수、치료비용차이균유통계학의의(P<0.05).결론 복벽견인법복강경유문배기절개술교전통기복법복강경수술경간편、경제,병발증상대소,유일정적응용개치.
Objective To compare the two ways for laparoscopic pyloromyotomy and evaluate the clinical effects of gasless laparoscopic pyloromyotomy with abdominal wall lifting. Methods Sixty-six infants with congenital hypertrophic pyloric stenosis were referred to Children's hospital Zhejiang u-niversity school of medicine from Mar 2006 to Sep 2007. Among them,21 were performed laparoscopic pyloromyotomy with abdominal wall lifting(group A),45 were performed laparoscopic pyloromyotomy with pneumoperitoneum (group B). Their vital signs and blood gas analysis during the operations, complications and cost were watched. Results Ten minutes after pneumoperitoneum beginning, the data of pH, PCO2 and HCO3- change a lot from the preoperative, there are statistically significant differences (P<0.05). In group A,all data were stable and there is no statistically difference. The oc-casional vomiting rates of two groups are similar. There are statistically significant differences between the two groups at the respiratory tract infection rate, hospital days and medical cost(P<0.05). Conclu-sions Laparoscopic pyloromyotomy with abdominal wall lifting is a useful and effective method for congenital hypertrophic pyloric stenosis.