Pyloric Stenosis

What is pyloric stenosis?

Pyloric stenosis is a narrowing of the pylorus, the opening from the stomach, into the small intestine. This type of blockage is also referred to as a gastric outlet obstruction. 正常情况下，食物很容易从胃通过幽门进入十二指肠. In pyloric stenosis, the muscles of the pylorus are abnormally thickened, which prevents the stomach from emptying into the small intestine, and food backs up into the esophagus. 增厚的原因尚不清楚，尽管遗传因素可能起作用. The condition is usually diagnosed by the time a child is six months old.

Symptoms

Vomiting is the first symptom in most children:

Vomiting may occur after every feeding or only after some feedings.
呕吐通常在三周左右开始，但也可能在一周到五个月大的任何时候开始.
呕吐强烈(抛射性呕吐)，呕吐物本身通常是透明的，或有部分消化(凝固)的奶样.
The infant is hungry after vomiting and wants to feed again.

Other symptoms generally appear several weeks after birth and may include:

Abdominal pain
Belching
Constant hunger
Dehydration (gets worse with the severity of the vomiting)
Failure to gain weight or weight loss
进食后不久和呕吐前腹部的波浪状运动

Diagnosis

The condition is usually diagnosed before the baby is six months old. A physical exam may reveal signs of dehydration. The doctor may detect the abnormal pylorus, which feels like an olive within the abdomen, when pressing over the stomach. An ultrasound of the abdomen may be the first imaging test performed. 其他检查可能包括钡x光检查，以显示胃和幽门的形状.

Treatment

幽门狭窄的第一种治疗形式是通过血液检查和静脉输液来识别和纠正身体化学的任何变化. 幽门狭窄通常通过手术治疗，几乎可以永久治愈. The operation, called a pyloromyotomy, divides the thickened outer muscle, while leaving the internal layers of the pylorus intact. 这打开了一个更宽的通道，使胃中的内容物更容易进入肠道.

A minimally invasive approach to abdominal surgery, 腹腔镜手术通常是治疗幽门狭窄的首选手术. To perform laparoscopic surgery, 外科医生通过一个小切口将一根坚硬的管子(称为套管针)插入腹腔。. 该管允许外科医生将一个小摄像机放入腹部，并通过外部监视器观察内部结构. The abdomen is inflated with carbon dioxide gas, 这样就能腾出空间来观察腹部的内容物并进行手术. 额外的刚性管通过小切口放置，用于将小型手术器械插入腹部. 这些仪器与照相机一起使用来执行手术. 手术结束后，取出导管和器械，缝合切口，随着时间的推移被身体吸收.

腹腔镜幽门切开术通常需要使用两个或三个套管针, and therefore usually requires two or three small incisions. 如果外科医生认为腹腔镜手术不是治疗在手术室中发现的问题的最佳方法, 然后手术将改变(转换)使用较旧的手术技术. 转换为非腹腔镜手术(称为“开放式手术”)是罕见的，需要更大的切口, which may take longer to heal.

Recovery

In general, 接受手术治疗幽门狭窄的患者有很好的恢复，很少遭受任何长期的问题，作为该疾病的结果. After surgery, 你的宝宝可能会被喂食一到两次特殊的液体，然后在24小时内母乳或配方奶粉.

The hospital stay following a pyloromyotomy is typically one or two days, 让推荐十大正规网赌平台出院的决定是基于孩子恢复得有多好:具体来说, 如果婴儿能够喝母乳或配方奶而不呕吐，并且疼痛可以通过口服药物来控制. 婴儿在手术后的头一两天有少量呕吐是正常的, but this should gradually improve. If your baby continues to vomit after you return home, call your doctor, 因为这可能表明持续的阻塞阻碍了胃的正常排空.

Following all operations, parents or caregivers will be provided with a list of instructions, 包括具体的警告标志，需要与外科团队沟通或引起医生的注意(无论是在急诊室还是儿科医生办公室)。. 家长和其他护理人员应首先参考书面出院说明，并使用提供的电话号码与儿科外科团队联系，讨论任何问题. 这些说明是在考虑到特定患者的医疗状况后提供的, the operation performed and how well the patient is recovering. Therefore, 如果出现问题，出院时(或之后通过电话或在儿科外科诊所)收到的指示是父母和护理人员的最佳资源. In general, 下列发现应引起关注，并要求推荐十大正规网赌平台去看医生:

Fever greater than 101.3 F by oral or rectal thermometer
手术伤口泛红，渗出液体，看起来像脓.
Increased bloody drainage from wound. Small amounts of yellow, pink, 或者被伤口敷料吸收的带血的分泌物是正常的, and should go away in three to five days.
疼痛加重，出院时服药不能改善.
恶心和呕吐阻止孩子喝清液体——这可能与某些止痛药或抗生素有关，如果这些药物与食物一起服用可能会改善.
The patient cannot move his or her bowels. Some medications cause constipation, 因此，外科团队可能会开大便软化剂或轻度泻药来帮助排便. 如果这些治疗无效，可能会有更严重的问题.