Sampson L K, Georgeson K E, Royal S A
The University of Alabama at Birmingham, Department of Surgery, The Children's Hospital of Alabama, 35233, USA.
J Pediatr Surg. 1998 Feb;33(2):282-5. doi: 10.1016/s0022-3468(98)90448-1.
BACKGROUND/PURPOSE: A significant number of children (50%) with gastroesophageal reflux (GER) have delayed gastric emptying (DGE). Although controversial, many pediatric surgeons use a gastric outlet procedure in conjunction with fundoplication for gastroesophageal reflux in these patients. This paper describes the technique and clinical outcome of 61 patients undergoing a laparoscopic gastric antroplasty at the time of the laparoscopic fundoplication.
The charts of 61 patients who underwent laparoscopic gastric antroplasty in conjunction with laparoscopic fundoplication between May 26, 1992 and October 17, 1996 were reviewed retrospectively. All patients had a documented DGE confirmed by a liquid isotope meal being retained in the stomach. After completion of the fundoplication, a laparoscopic antroplasty was performed by incising a 2 to 3.5-cm linear incision in the pylorus and distal gastric antrum. The seromuscular wall was divided to the level of the mucosa allowing the mucosa to bulge through the defect. The wound was closed transversely using interrupted 2-0 silk sutures.
Four of the 61 patients underwent conversion to open antroplasty for technical reasons. The remaining 57 patients recovered uneventfully from the laparoscopic antroplasty with clinical resolution of both GER and DGE. Two of 57 patients had intermittent episodes of retching and were unable to tolerate large bolus feedings because of dumping. They were treated by dividing the feedings into two smaller portions. These symptoms cleared within 6 months. The remaining 55 patients have tolerated feedings well. Evaluation of the gastric emptying was performed randomly in selected patients with documented improvement of the emptying after antroplasty. An evisceration of omentum through the umbilical incision developed in one patient on the third postoperative day.
Patients with delayed gastric emptying who need fundoplication can be treated with laparoscopic gastric antroplasty in conjunction with laparoscopic fundoplication. Laparoscopic antroplasty appears to be clinically efficacious in improving delayed gastric emptying.
背景/目的：相当数量（50%）的胃食管反流（GER）患儿存在胃排空延迟（DGE）。尽管存在争议，但许多小儿外科医生在为这些患者进行胃底折叠术时会联合采用胃出口手术。本文描述了61例在腹腔镜胃底折叠术时同期接受腹腔镜胃窦成形术患者的手术技术及临床结果。
回顾性分析1992年5月26日至1996年10月17日期间61例同期接受腹腔镜胃窦成形术和腹腔镜胃底折叠术患者的病历。所有患者均经液体同位素餐在胃内潴留证实存在胃排空延迟。胃底折叠术完成后，在幽门和远端胃窦做一个2至3.5厘米的线性切口，进行腹腔镜胃窦成形术。将浆肌层切开至黏膜层，使黏膜从缺损处膨出。用2-0间断丝线横向缝合伤口。
61例患者中有4例因技术原因转为开放胃窦成形术。其余57例患者腹腔镜胃窦成形术后恢复顺利，GER和DGE均得到临床缓解。57例患者中有2例出现间歇性干呕，因倾倒综合征无法耐受大量推注喂养。通过将喂养量分为两小份进行治疗。这些症状在6个月内消失。其余55例患者喂养耐受良好。对部分胃排空记录改善的患者随机进行胃排空评估。1例患者术后第3天经脐部切口发生网膜脱出。
需要进行胃底折叠术的胃排空延迟患者可采用腹腔镜胃窦成形术联合腹腔镜胃底折叠术治疗。腹腔镜胃窦成形术在改善胃排空延迟方面似乎具有临床疗效。
