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目的探讨超声及钡剂造影在内镜下幽门括约肌切开术治疗先天性肥厚性幽门狭窄(CHPS)中的应用价值。方法行胃镜下幽门括约肌切开术的CHPS患儿20例,应用二维超声诊断CHPS,并测量手术前后幽门管的长径、外径、管壁厚度、肌层厚度、黏膜及黏膜下层厚度;同时根据超声所测幽门管肌层及黏膜层厚度指导手术时电凝刀切开幽门管壁的厚度;利用钡剂造影诊断CHPS并对比手术前后的造影结果。结果超声检查显示术后幽门管的长度、外径、肌层厚度均较术前减少,幽门舒张时可见幽门管腔不同程度地开放,液体顺利通过管腔,管腔随着幽门的舒张、收缩有规律地开放、闭合。术后钡剂造影显示钡剂顺利通过幽门管。结论超声与钡剂造影均是诊断CHPS的可靠方法,超声检查对内镜下幽门括约肌切开术的指导价值更大。
Objective To investigate the value of ultrasound and barium contrast-enhanced radiography in the treatment of congenital hypertrophic pyloric stenosis (CHPS) by endoscopic pyloric sphincterotomy. Methods Twenty patients with CHPS underwent gastroscopic pyloric sphincterotomy were enrolled in this study. CHPS was diagnosed by two - dimensional ultrasonography and the long diameter, outer diameter, wall thickness, muscular layer thickness, mucosal and submucosal thickness of pyloric tube before and after operation were measured. At the same time, the thickness of pyloric myometrium and mucosal layer was used to guide the operation. The thickness of pyloric wall was cut by coagulation knife. The contrast of CHPS was diagnosed by contrast-enhanced barium contrast and the contrast before and after operation was compared. Results Ultrasound examination showed that the length of pylorus tube, the diameter of outer layer and the thickness of myometrium were decreased compared with those before operation. When the pyloric dilatation was observed, the pyloric lumen opened to varying degrees and the liquid passed through the lumen smoothly. Regularly open, closed. Postoperative barium contrast showed that barium passed smoothly through the pyloric tube. Conclusion Both ultrasound and barium contrast are reliable methods for the diagnosis of CHPS. Ultrasonography is more valuable for endoscopic pyloric sphincterotomy.