Tao Boyuan,Zeng Jixiao,Liu Fei,et al.Application of Heineke-Mikulicz pyloroplasty for benign gastric outlet obstruction in children[J].Journal of Clinical Pediatric Surgery,2023,22(04):345-350.[doi:10.3760/cma.j.cn101785-202205045-009]
Heineke-Mikulicz幽门成形术在儿童胃流出道梗阻良性病变中的应用
- Title:
- Application of Heineke-Mikulicz pyloroplasty for benign gastric outlet obstruction in children
- Keywords:
- Gastric Outlet Obstruction; Pyloric Stenosis; Pyloroplasty; Child
- 摘要:
- 目的 探讨Heineke-Mikulicz幽门成形术(Heineke-Mikulicz pyloroplasty,HMP)在儿童胃流出道梗阻良性病变中的应用指征及手术疗效。方法 回顾性分析广州医科大学附属广州市妇女儿童医疗中心胃肠外科2015年8月至2021年1月收治的11例因良性胃流出道梗阻病变接受HMP患儿临床资料。其中4例为消化性溃疡致幽门或十二指肠球部狭窄;3例为胃壁肿物(2例为异位胰腺,1例为胃重复畸形);2例为嗜酸性粒细胞性胃肠炎致幽门狭窄;1例为先天性肥厚性幽门狭窄幽门环肌切开术后幽门再梗阻;1例为化学性损伤致胃窦近幽门处狭窄。收集所有患儿年龄、手术情况及术后恢复情况。结果 11例患儿中,男5例、女6例;平均年龄5岁1个月。均成功施行HMP,其中9例行开放手术,2例行腹腔镜手术。手术时间(162±92)min,术中出血量(10±3)mL,术后住院时间(12±4)d。11例共行14次手术。1例化学性损伤患儿出院时需半流质饮食,其余10例恢复至正常饮食。术后随访(38±23)个月,术后6个月随访有2例饱食后偶有轻微腹痛,1例偶有胃潴留,均经保守治疗好转;术后12个月随访患儿身高、身体质量发育正常,身体质量指数、血清白蛋白和前白蛋白情况均较术前明显改善(P＜0.05)。结论 HMP是治疗儿童胃流出道梗阻良性病变的有效方法,近期和中期效果良好。
- Abstract:
- Objective To explore the indications and efficacies of Heineke-Mikulicz pyloroplasty (HMP) for benign gastric outlet obstruction in children.Methods From August 2015 to January 2021,clinical data were retrospectively reviewed for 11 children undergoing HMP for benign gastric outlet obstruction.There were pyloric or duodenal bulb stenosis caused by peptic ulcer (n=4),gastric mass (n=3,including ectopic pancreatic tissue,n=2;gastric duplication,n=1);pyloric stenosis caused by eosinophilic gastroenteritis (n=2),recurrence of pyloric obstruction after laparoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis (n=1) and stenosis of distal gastric antrum caused by chemical injury (n=1). Results There were 5 boys and 6 girls with a mean age of 5.1 years old.Pyloroplasty was successful.Laparotomy (n=9) and laparoscopy (n=2) were performed.Operative duration was (162±92) min,estimated blood loss (10±3) ml and postoperative length of stay (12±4) days.A total of 14 operations were performed.One child of corrosive ingestion required a semi-liquid diet during discharge and the remainders could eat normally.The postoperative follow-up period was (38±23) months.One child had transient gastric retention within six months post-operation and improved after conservative measures.Two children had mild abdominal pain after eating.At Month 12 post-operation,height and weight normalized and body mass index,serum albumin and prealbumin improved markedly as compared with those pre-operation (P<0.05). Conclusion As an effective treatment of benign gastric outlet obstruction in children,HMP may achieve excellent near/medium-term outcomes.
参考文献/References:
[1] Lovasik BP,Dodson TF,Srinivasan JK.Heineke,Mikulicz,Jaboulay,and Finney:innovators of surgical pyloroplasty[J].Am Surg,2021,87(5):737-740.DOI:10.1177/0003134820952820.
[2] S?reide K,Sarr MG,S?reide JA.Pyloroplasty for benign gastric outlet obstruction-indications and techniques[J].Scand J Surg,2006,95(1):11-16.DOI:10.1177/145749690609500103.
[3] Al-Ansari A,Altokhais TI.Recurrent pyloric stenosis[J].Pediatr Int,2016,58(7):619-621.DOI:10.1111/ped.12958.
[4] Simeonov M,Yonkov A.Recurrent hypertrophic pyloric stenosis-diagnostics and treatment[J].Khirurgiia (Sofiia),2016,82(2):52-56.
[5] Mazurak M,Patkowski D.A history of the surgical correction of pyloric stenosis[J].J Pediatr Surg,2021,56(10):1904-1907.DOI:10.1016/j.jpedsurg.2021.05.009.
[6] 潘静,杨天佑,杨纪亮,等.小儿胃部占位性病变的诊治分析[J].临床小儿外科杂志,2017,16(5):439-443.DOI:10.3969/j.issn.1671-6353.2017.05.006. Pan J,Yang TY,Yang JL,et al.Diagnosis and treatment of space-occupying gastric mass in children[J].J Clin Ped Sur,2017,16(5):439-443.DOI:10.3969/j.issn.1671-6353.2017.05.006.
[7] Liu F,Xu XG,Lan ML,et al.Clinical characteristics of gastric duplication in children[J].Front Pediatr,2022,10:857056.DOI:10.3389/fped.2022.857056.
[8] Doya LJ,Hassan NT,Bijow FW,et al.An unusual cause of recurrent pediatric vomiting (an extraluminal pyloric duplication cystic):a case report[J].Oxf Med Case Reports,2020,2020(12):omaa119.DOI:10.1093/omcr/omaa119.
[9] Fang Y,Gao TJ,Yang HB,et al.Removal of an infant’s gastric duplication cyst through endoscopic submucosal dissection:a case report[J].Medicine (Baltimore),2019,98(12):e14820.DOI:10.1097/MD.0000000000014820.
[10] Noh JH,Kim DH,Kim SW,et al.Endoscopic submucosal dissection as alternative to surgery for complicated gastric heterotopic pancreas[J].World J Clin Cases,2020,8(20):4708-4718.DOI:10.12998/wjcc.v8.i20.4708.
[11] Gong EJ,Kim DH,Jung HY,et al.Clinical outcomes of endoscopic resection for gastric neoplasms in the pylorus[J].Surg Endosc,2015,29(12):3491-3498.DOI:10.1007/s00464-015-4099-8.
[12] Gryboski JD.Peptic ulcer disease in children[J].Med Clin North Am,1991,75(4):889-902.DOI:10.1016/s0025-7125(16)30419-9.
[13] Chao HC.Update on endoscopic management of gastric outlet obstruction in children[J].World J Gastrointest Endosc,2016,8(18):635-645.DOI:10.4253/wjge.v8.i18.635.
[14] 朱莉,龙梅,王颖.儿童嗜酸性粒细胞性胃肠炎[J].中国实用儿科杂志,2021,36(4):245-249.DOI:10.19538/j.ek2021040602. Zhu L,Long M,Wang Y.Eosinophilic gastroenteritis in children[J].Chin J Pract Pediatr,2021,36(4):245-249.DOI:10.19538/j.ek2021040602.
[15] Talley NJ,Shorter RG,Phillips SF,et al.Eosinophilic gastroenteritis:a clinicopathological study of patients with disease of the mucosa,muscle layer,and subserosal tissues[J].Gut,1990,31(1):54-58.DOI:10.1136/gut.31.1.54.
[16] Koutri E,Papadopoulou A.Eosinophilic gastrointestinal diseases in childhood[J].Ann Nutr Metab,2018,73(Suppl 4):18-28.DOI:10.1159/000493668.
[17] Vargas-Rubio R,Meek-Benigni E,Henao-Pérez F,et al.Gastric outlet obstruction as manifestation of eosinophilic gastroenteritis[J].Rev Gastroenterol Peru,2020,40(2):173-176.DOI:10.47892/rgp.2020.402.1086.
[18] Soomro MA,Aftab M,Hasan M,et al.Heineke-Mikulicz pyloroplasty for isolated pyloric stricture caused by corrosive ingestion in children[J].Pak J Med Sci,2020,36(1):S87-S90.DOI:10.12669/pjms.36.ICON-Suppl.1714.
[19] ?zokutan BH,Ceylan H,Erta ? kinI[DD(-*4]·,et al.Pediatric gastric outlet obstruction following corrosive ingestion[J].Pediatr Surg Int,2010,26(6):615-618.DOI:10.1007/s00383-010-2613-6.
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备注/Memo
收稿日期:2022-9-9。
基金项目:国家自然科学基金(82170528);广东省自然科学基金(2022A1515012254);广州市科技计划市校(院)联合资助项目(202201020612);广州市临床特色技术项目(2023C—TS48)
通讯作者:曾纪晓,Email:zengjixiao@163.com