Emil S
Division of Pediatric Surgery, Miller Children's Hospital, Long Beach, CA, USA.
Eur J Pediatr Surg. 2009 Apr;19(2):72-5. doi: 10.1055/s-2008-1039197. Epub 2009 Feb 17.
The optimal incision for pyloromyotomy remains controversial.
A new pyloromyotomy incision has been developed. The incision is placed circumferentially in the infra-umbilical crease, and accesses the pylorus after dividing the umbilical stalk and enlarging the natural umbilical defect. After the pyloromyotomy, the fascia is closed, simultaneously repairing any concomitant umbilical hernia. Patients were followed up at 2 weeks and at three months after operation. The results of the first 14 consecutive operations over a 5-month period by, or under the supervision of, one staff surgeon are reported.
All 14 pyloromyotomy were successfully completed through the infra-umbilical incision. The series included 4 patients with metabolic alkalosis requiring preoperative correction. One duodenal perforation was recognized and repaired. Mean age and weight of the patients was 31.2 days (range 13-55), and 3 754 g (range 2,880-5,400), respectively. Mean operation time was 28.4 minutes (range 17-46). Mean duration between operation and discharge was 1.93 days (range 1-6), and mean total hospital stay was 2.8 days (range 1-8). There were no immediate or delayed wound complications. A virtually scarless appearance was seen in all patients on follow-up.
A new infra-umbilical pyloromyotomy combines the benefits of the laparoscopic and open approaches and results in superb cosmesis.
幽门肌切开术的最佳切口仍存在争议。
已开发出一种新的幽门肌切开术切口。该切口环绕置于脐下皱襞处，在切断脐蒂并扩大天然脐部缺损后进入幽门。幽门肌切开术后，关闭筋膜，同时修复任何合并的脐疝。术后2周和3个月对患者进行随访。报告了一名外科医生在5个月内主刀或指导下连续进行的前14例手术的结果。
所有14例幽门肌切开术均通过脐下切口成功完成。该系列包括4例术前需要纠正代谢性碱中毒的患者。发现并修复了1例十二指肠穿孔。患者的平均年龄和体重分别为31.2天（范围13 - 55天）和3754克（范围2880 - 5400克）。平均手术时间为28.4分钟（范围17 - 46分钟）。手术至出院的平均时长为1.93天（范围1 - 6天），平均总住院时间为2.8天（范围1 - 8天）。无即刻或延迟的伤口并发症。随访时所有患者均呈现几乎无瘢痕的外观。
一种新的脐下幽门肌切开术结合了腹腔镜和开放手术方法的优点，且美容效果极佳。
