CAJ | 학술논문

目的探讨非肥厚性幽门狭窄的诊断、治疗方法及手术方式的选择.方法回顾性研究我院2007年4月至2012年4月收治的110例儿童幽门梗阻,其中非先天性肥厚性幽门梗阻18例.2例幽门痉挛,2例幽门前瓣膜,9例水肿瘢痕性幽门狭窄,3例溃疡性幽门狭窄,1例幽门肿瘤,1例Jodhpu病.总结非肥厚性幽门梗阻的典型症状及治疗特点.结果有明确病因者5例.本组4例保守治疗,1例介入下置入空场营养管后继续保守治疗,1例介入下球囊扩张术,余12例均行手术治疗,手术组术前明确诊断者4例.手术方式采取幽门成形术、瓣膜切除+幽门成形术、胃十二指肠吻合术(BillrothⅠ式吻合)、胃空肠Roux-en-Y吻合术,随访0.5～5.5年,平均(2.47±2.0)年,呕吐症状消失15例,饱食后偶出现呕吐3例.结论非肥厚性幽门梗阻临床类型较多,术前明确病因诊断较困难,治疗方式多样,对于儿童幽门管切除、迷走神经切断应慎重考虑,以减少倾倒综合征及胃排空障碍的发生,建议针对溃疡及肿瘤病变可切除幽门管,其余均可保守治疗或行幽门成形术、胃空肠Roux-en-Y吻合术等替代手术.
목적 탐토비비후성유문협착적진단、치료방법급수술방식적선택.방법 회고성연구아원2007년4월지2012년4월수치적110례인동유문경조,기중비선천성비후성유문경조18례.2례유문경련,2례유문전판막,9례수종반흔성유문협착,3례궤양성유문협착,1례유문종류,1례Jodhpu병.총결비비후성유문경조적전형증상급치료특점.결과 유명학병인자5례.본조4례보수치료,1례개입하치입공장영양관후계속보수치료,1례개입하구낭확장술,여12례균행수술치료,수술조술전명학진단자4례.수술방식채취유문성형술、판막절제+유문성형술、위십이지장문합술(BillrothⅠ식문합)、위공장Roux-en-Y문합술,수방0.5～5.5년,평균(2.47±2.0)년,구토증상소실15례,포식후우출현구토3례.결론 비비후성유문경조림상류형교다,술전명학병인진단교곤난,치료방식다양,대우인동유문관절제、미주신경절단응신중고필,이감소경도종합정급위배공장애적발생,건의침대궤양급종류병변가절제유문관,기여균가보수치료혹행유문성형술、위공장Roux-en-Y문합술등체대수술.
Objective To evaluate the diagnosis and surgical treatment for non-hypertrophic pyloric stenosis (NHPS).Methods Clinical data of 110 cases of pyloric stenosis,treated during April 2007 to April 2012 in our hospital,were analyzed and evaluated retrospectivelly.In this group,18 cases were diagnosed as NHPS,which includes 2 cases of pylorospasm,2 cases of prepyloric membrane,9 cases of pyloric stenosis caused by edema,3 cases complicated with peptic ulcer,1 case of pyloric tumor and 1case of Jodhpu disease.The typical symptoms and therapy strategies of nonhypertrophic pyloric stenosis were summarized.Results In the 5 cases with definite causes,4 cases were treated by conservative therapy,1 case continued conservative therapy after placing jejunum feeding tube under interventional radiography,1 case underwent balloon dilatation under interventional radiography; the remaining 12 cases were treated by surgery.Only 4 cases got correct diagnosis before operation.Pyloroplasty,membrane excision or pyloroplasty,gastroduodenostomy (Billroth Ⅰ anastomosis),Roux-en-Y gastrojejunostomy were applied to these patients.Vomiting disappeared in 15 cases and occasionally occurred with full stomach in 3 cases during the follow up of 0.5 to 5.5 years (2.47 ± 2.0 years on average).Conclusions Non-hypertrophic pyloric stenosis can be caused by various diseases,which is difficult to be diagnosed before surgery.Surgical treatment options should be chosen based on the variety of the causes.