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目的研究比较腹腔镜幽门环肌切开术(LP)和开腹幽门环肌切开术(OP)治疗先天性幽门肥厚性狭窄的疗效及免疫功能的变化。方法自2003年4月～2006年7月将72例先天性幽门肥厚性狭窄患儿随机分成二组(LP组及OP组各36例),比较二组麻醉时间、手术时间、术后进食时间及术后并发症,监测二组术前、术后第一天、术后第三天的外周血T淋巴细胞亚群、C反应蛋白(CRP)及白细胞介素-6(IL-6)和肿瘤坏死因子(TNF)的变化并行对比研究。结果二组麻醉时间、手术时间、术后进食时间差异无统计学意义,OP组术后并发症要略多于LP组,比较二组术前、术后第一天、术后第三天的外周血T淋巴细胞亚群、CRP及IL-6和TNF的变化差异无统计学意义。结论腹腔镜幽门环肌切开术(LP)和开腹幽门环肌切开术(OP)治疗先天性幽门肥厚性狭窄的临床效果相近,二组患儿免疫功能的变化无显著性差异。腹腔镜幽门环肌切开术是一种稳定、可靠的手术,对于治疗先天性肥厚性幽门狭窄的效果满意。
Objective To compare the efficacy and immunologic function of laparoscopic pyloric myringomyotomy (LP) and open pyloric myringotomy (OP) in the treatment of congenital pyloric hypertrophic stenosis. Methods From April 2003 to July 2006, 72 children with congenital pyloric hypertrophic stenosis were randomly divided into two groups (LP group and OP group, 36 cases each). The anesthesia time, operation time, postoperative eating time And postoperative complications. The levels of T lymphocyte subsets, C-reactive protein (CRP) and interleukin-6 (IL-6) in the peripheral blood were monitored before operation, on the first postoperative day, Tumor necrosis factor (TNF) changes in parallel comparative study. Results There was no significant difference in anesthesia time, operation time and postoperative eating time between the two groups. The postoperative complication in OP group was slightly more than that in LP group. Comparing the two groups before operation, on the first postoperative day, on the third postoperative day Blood T lymphocyte subsets, CRP, IL-6 and TNF showed no significant difference. Conclusion The clinical effects of laparoscopic pyloric myringomyotomy (LP) and open pyloric myringomyotomy (OP) for the treatment of congenital pyloric hypertrophic stenosis are similar. There was no significant difference in immune function between the two groups. Laparoscopic pyloricomyotomy is a stable and reliable operation and is satisfactory for the treatment of congenital hypertrophic pyloric stenosis.