Costanzo Caitlyn M, Vinocur Charles, Berman Loren
Department of Surgery, Nemours Alfred I DuPont Hospital for Children, Wilmington, Delaware; Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Department of Surgery, Nemours Alfred I DuPont Hospital for Children, Wilmington, Delaware; Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
J Surg Res. 2018 Apr;224:240-244. doi: 10.1016/j.jss.2017.08.040. Epub 2018 Jan 8.
Hypertrophic pyloric stenosis (HPS) is one of the most common indications for non-elective surgery in the neonatal population. Multiple small prospective trials have shown that postoperative outcomes for laparoscopic versus open pyloromyotomy are equivalent or slightly better with the minimally invasive approach. This study uses a prospective national database to compare postoperative complications and length of stay for infants undergoing laparoscopic versus open pyloromyotomy.
Infants undergoing either open or laparoscopic pyloromyotomy for HPS were identified from the 2013 National Surgical Quality Improvement Project-Pediatric Participant Use File. Post-operative complication rates for an open versus laparoscopic approach were compared using chi square or Fisher's exact test as appropriate. Operative time and post-operative length of stay were compared using the Wilcoxon two-sample test.
A total of 3256 infants were identified from the 2013 and 2014 American College of Surgeons National Surgical Quality Improvement Project-Pediatric Participant Use File who underwent pyloromyotomy for HPS. Of these, 1182 were open and 2074 were laparoscopic. Postoperative outcomes are depicted in Table 2. Laparoscopic pyloromyotomy was associated with statistically significant decrease in overall morbidity (2.4% versus 1.2%, P = 0.007).
We have demonstrated that post-operative outcomes after laparoscopic pyloromyotomy are equivalent or superior to an open approach. The minimally invasive approach to pyloromyotomy is a safe and feasible option in the treatment of HPS in infants.
肥厚性幽门狭窄（HPS）是新生儿非选择性手术最常见的适应证之一。多项小型前瞻性试验表明，腹腔镜与开放幽门肌切开术的术后结果相当，或微创方法的结果略优。本研究使用前瞻性全国数据库比较接受腹腔镜与开放幽门肌切开术的婴儿的术后并发症和住院时间。
从2013年国家外科质量改进项目 - 儿科参与者使用文件中识别出接受开放或腹腔镜幽门肌切开术治疗HPS的婴儿。使用卡方检验或Fisher精确检验（视情况而定）比较开放与腹腔镜手术方法的术后并发症发生率。使用Wilcoxon双样本检验比较手术时间和术后住院时间。
从2013年和2014年美国外科医师学会国家外科质量改进项目 - 儿科参与者使用文件中总共识别出3256例接受幽门肌切开术治疗HPS的婴儿。其中，1182例为开放手术，2074例为腹腔镜手术。术后结果见表2。腹腔镜幽门肌切开术与总体发病率的统计学显著降低相关（2.4%对1.2%，P = 0.007）。
我们已经证明，腹腔镜幽门肌切开术后的结果与开放手术相当或更优。幽门肌切开术的微创方法是治疗婴儿HPS的安全可行选择。
