Yamataka A, Tsukada K, Yokoyama-Laws Y, Murata M, Lane G J, Osawa M, Fujimoto T, Miyano T
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
J Pediatr Surg. 2000 Feb;35(2):338-41; discussion 342. doi: 10.1016/s0022-3468(00)90036-8.
Atropine sulfate (atropine) and pyloromyotomy were compared for managing infantile hypertrophic pyloric stenosis (IHPS).
From 1996 to 1998, cases of IHPS treated surgically (pyloromyotomy; n = 20) or medically (atropine; n = 14) at separate institutions were compared retrospectively with regard to status on presentation, physical symptoms and signs, progress, and costs. Atropine was given orally, then intravenously if ineffective. Refractory cases were referred for pyloromyotomy.
All subjects were matched for clinical and physiological status on admission. Oral atropine alone was effective in 11 cases, was converted to intravenous atropine in 2 cases, and was terminated in 1 case because of hematemesis. Two cases were referred for pyloromyotomy. All pyloromyotomies were successful. Atropine took on average, 2.6 days to take effect. The difference in time taken for normalization of pyloric muscle thickness between the 2 groups was not significant. Average time to return to full feeding was longer in the atropine group (P<.01). Costs were lower in the atropine group (P<.01). There were 2 wound infections in the pyloromyotomy group, but no adverse effects of atropine. There were no recurrences in either group.
This study provides reasonable evidence to support a trial of atropine in IHPS.
比较硫酸阿托品（阿托品）和幽门肌切开术治疗婴儿肥厚性幽门狭窄（IHPS）的效果。
回顾性比较1996年至1998年期间在不同机构接受手术治疗（幽门肌切开术；n = 20）或药物治疗（阿托品；n = 14）的IHPS病例，比较其就诊时的状况、身体症状和体征、病情进展及费用。阿托品先口服，无效则静脉注射。难治性病例转诊接受幽门肌切开术。
所有受试者入院时的临床和生理状况相匹配。单用口服阿托品治疗，11例有效，2例改为静脉注射阿托品，1例因呕血终止治疗。2例转诊接受幽门肌切开术。所有幽门肌切开术均成功。阿托品平均起效时间为2.6天。两组间幽门肌厚度恢复正常所需时间差异无统计学意义。阿托品组完全恢复经口喂养的平均时间更长（P<0.01）。阿托品组费用更低（P<0.01）。幽门肌切开术组有2例伤口感染，但阿托品无不良反应。两组均无复发。
本研究提供了合理证据支持对IHPS进行阿托品试验。
