Department of Surgery, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA.
J Pediatr Surg. 2009 Nov;44(11):2119-25. doi: 10.1016/j.jpedsurg.2009.02.067.
The aim of this study is to compare the outcome of 3 different approaches to pyloromyotomy in a large single institution series.
Records of consecutive patients undergoing pyloromyotomy for an 8-year period were reviewed. Patients' age, sex, weight, operating time, length of stay, number of emeses, and complications were recorded. Variables were compared between right upper quadrant (RUQ), umbilical (UMB), and laparoscopic (LAP) approaches.
Six hundred twenty-two patients were included in the study. Operating time was significantly shorter for LAP and RUQ compared to UMB. Length of stay did not differ between the groups. There were fewer episodes of emesis in the LAP group. There was a trend toward a higher rate of complications in UMB group.
Outcomes after pyloromyotomy are institution dependent and cannot be generalized. Patient safety is the first concern, followed by patient comfort and cosmesis. Laparoscopic pyloromyotomy can be as fast and efficient as open, without an increased rate of complications, with excellent cosmetic results, and less analgesic requirement. If skill and experience to replicate good outcomes of laparoscopy are not available, open pyloromyotomy is a safer technique. The UMB approach is an alternative method to achieve good cosmesis without laparoscopy in the hands of a surgeon proficient in this method.
本研究旨在比较在单一大型机构系列中 3 种不同幽门肌切开术方法的结果。
回顾了 8 年来连续接受幽门肌切开术的患者的记录。记录了患者的年龄、性别、体重、手术时间、住院时间、呕吐次数和并发症。比较了右上象限（RUQ）、脐部（UMB）和腹腔镜（LAP）方法之间的变量。
本研究共纳入 622 例患者。与 UMB 相比，LAP 和 RUQ 的手术时间明显更短。各组之间的住院时间没有差异。LAP 组呕吐次数较少。UMB 组并发症发生率呈上升趋势。
幽门肌切开术的结果取决于机构，不能一概而论。患者安全是首要考虑因素，其次是患者舒适度和美容效果。腹腔镜幽门肌切开术可以像开放手术一样快速有效，且并发症发生率没有增加，具有良好的美容效果，且对镇痛的需求更少。如果没有复制腹腔镜良好效果的技能和经验，开放幽门肌切开术是一种更安全的技术。对于熟练掌握该方法的外科医生来说，UMB 方法是一种无需腹腔镜即可获得良好美容效果的替代方法。
