论文部分内容阅读
患儿,女,25天。因出生后进食呕吐入院。患儿出生后第1天吸奶后即有溢奶,逐渐加重,每次喂奶后即出现喷射性呕吐,不含胆汁,吐后可继续进食。大便次数少,干燥,黄绿色;尿量可,体重增长缓慢,门诊以“先天性肥厚性幽门狭窄”收入院。患儿系第2胎第2产,足月顺产,生后24小时排出胎便。查体:体重3.2kg,发育正常,营养差,精神不振。皮肤弹性较差,皮下脂肪薄。前胸平坦,心肺未见异常,腹软,上腹部可见胃型,有胃蠕动波出现,未扪及明显包块。肠鸣音弱,腹透可见单气泡征,肠腔内充气少。入院诊断:先天性肥厚性幽门狭窄,于1993年3月2日在氯胺酮麻醉下手术。术中见幽门环肌轻度苍白,触之稍硬,肥厚不明显。切断幽门环肌,使粘膜膨出。探查胃体、十二指肠未见明显异常。术后次日开始进食,仍呕吐。手术后第3天行胃肠钡餐检查:经导管注入钡剂后见胃蠕动尚可。观察约5分钟未见钡剂进入十二指肠。考虑为先天性幽门闭锁。于1993年3月5日行2次手术。切开膨出粘膜,长约1.0cm,见幽
Children, women, 25 days. After eating due to vomiting after admission. After the first day of childbirth, there is overflow milk after sucking milk, which gradually aggravate. After each feeding, vomit appears as ejaculation without bile. After vomiting, it can continue to eat. Stool frequency less, dry, yellow-green; urine output, weight gain slow, out-patient to “congenital hypertrophic pyloric stenosis” income homes. The second child of the second-line fetus in children, full-term natural delivery, 24 hours after birth discharge meconium. Physical examination: body weight 3.2kg, normal development, poor nutrition, lack of energy. Poor skin elasticity, thin subcutaneous fat. Flat chest, no abnormal heart and lung, abdominal soft, visible upper stomach stomach, gastric motility wave appears, palpable mass was not palpable. Bowel sounds weak, see a single bubble signs of peritoneal dialysis, less intestinal inflatable. Admission diagnosis: congenital hypertrophic pyloric stenosis, March 2, 1993 under ketamine anesthesia surgery. Intraoperative pyloric muscle see mild pale, touch slightly harder, hypertrophy is not obvious. Cut off the pyloric muscle, mucosal bulging. Explore the body, no significant abnormal duodenum. After the next day began to eat, still vomiting. The first 3 days after surgery, gastrointestinal barium meal examination: see the gastric motility after barium injection via the catheter is acceptable. No barium was observed in the duodenum for about 5 minutes. Consider congenital pyloric atresia. On March 5, 1993, 2 surgeries were performed. Open the bulging mucosa, about 1.0cm, see secluded