目的 探讨先天性肥厚性幽门狭窄(congenital hypertrophic pyloric stenosis,IHPS)中神经元型一氧化氮合酶(neuronal nitric oxide synthase,nNOS)的表达情况,以进一步研究IHPS的发病机制。方法 选取4只Beagle孕犬按3:1分为模型组和对照组,自孕期第1天至分娩前1天,模型组孕犬每天腹腔注射一次L-NAME 6 mg/(kg.d),对照组给予同样方式注射等量的生理盐水。所有新生犬均在生后第31天、38天、45天及52天分别称重,生后52天,选取模型组中体质量增长缓慢的新生犬和对照组新生犬各5只作为实验对象,取幽门组织HE染色后显微镜下测量幽门环肌厚度,免疫组化后运用图像分析技术测定nNOS表达量。结果 与对照组新生犬比较,模型组中新生犬体质量增长慢,幽门环肌增厚,nNOS表达量减少,两组间有差异(P<0.01,P<0.01,P<0.05)。结论 幽门区nNOS表达减少与CHPS相关。

Objective To further study the pathogenesis of infantile hypertrophic pyloric stenosis(IHPS) by analyzing the expression of neuronal nitric oxide synthase(nNOS) in pylorus of CHPS. Methods According to 3:1,four Beagle pregnant dogs were selected and divided into model group and control group,from the first day of pregnancy to the first day before delivery, L-NAME was intraperitoneally injected into pregnant dogs in the model group, dose for 6mg/(kg.d),while normal saline was intraperitoneally injected into pregnant dogs in the control group.The two groups newborn dogs were weighed at 31, 38, 45 and 52 days after birth,At 52 days after birth, 5 newborn dogs were selected respectively between model group and control group as experimental subjects, obtained pyloric tissue for HE staining and measured the muscular thickness of pyloric,The expression of nNOS was determined by image analysis after immunohistochemistry. Results Compared with newborn dogs in the control group, newborn dogs in the model group had slow weight growth, increased pyloric annulus muscle thickness, and decreased expression of nNOS(P<0.01,P<0.01,P<0.05). Conclusion The decreased expression of nNOS in the pyloric region associated with IHPS.

目的 了解CHPS患儿经胃镜下幽门肌切开术治疗后幽门部黏膜近期各种并发症的发生情况及对预后的影响。方法 选取2006—2012年我院新生儿科确诊的34例CHPS患儿。以超细胃镜进入十二指肠乳头处,使用电切刀按上行性方向,沿幽门管纵轴切割肥厚狭窄的幽门管黏膜及环形肌以解除幽门部梗阻。术后第1、3、6月复查胃镜。结果 34例CHPS患儿共行胃镜下幽门肌切开术48次,均未发生胃及幽门穿孔、撕裂等严重并发症。24例患儿术后通过胃镜进行了复查,胃镜见幽门部及黏膜改变主要有黏膜充血肿胀、切口未完全愈合、切口疤痕形成、幽门部息肉形成等。结论 经胃镜下幽门肌切开术是一种安全性较高的治疗CHPS的新技术。术后黏膜充血肿胀、切口未完全愈合等幽门部黏膜改变的发生率随时间下降。切口疤痕形成并未影响幽门功能。