Okuyama H, Urao M, Starr G A, Drongowski R A, Coran A G, Hirschl R B
Section of Pediatric Surgery, CS Mott Children's Hospital, Ann Arbor, MI 48109-0245, USA.
J Pediatr Surg. 1997 Feb;32(2):316-9; discussion 319-20. doi: 10.1016/s0022-3468(97)90201-3.
Delayed gastric emptying (DGE) in children with gastroesophageal reflux (GER) is often treated with a gastric emptying procedure. Although pyloroplasty is the most common gastric emptying procedure performed, pyloromyotomy is easier to perform and is associated with less morbidity. The aim of this study was to compare the efficacy of pyloromyotomy and pyloroplasty in children with DGE and GER undergoing a fundoplication.
We reviewed the charts of 54 patients with DGE who underwent pyloromyotomy (n = 29), or pyloroplasty (n = 25) along with a fundoplication. A technetium 99-labeled sulfur colloid liquid-phase gastric emptying study (GES) was performed in the pre- and early postoperative period (within 6 months after operation). Normal stomach emptying was defined as greater than 40% at 1 hour. Comparisons were made with regard to postoperative complication rate, incidence of redo fundoplication, length of postoperative hospital stay, and pre- and postoperative GES.
The pyloroplasty and pyloromyotomy group were comparable in terms of age, sex, operative indications, and neurological status. There was no significant difference in the GES between the two groups preoperatively. There was a trend toward a decreased incidence of early postoperative complications including gas bloat, wound infection, pneumonia, dysphagia, bowel obstruction and dumping syndrome in the pyloromyotomy (8, 28%) when compared with the pyloroplasty group (12, 48%, P = .10). The mean postoperative hospital stay was 10.6 +/- 1.4 days for the pyloroplasty group and 7.6 +/- 1.0 days for the pyloromyotomy group (P + .08). The incidence of a redo fundoplication was 8% in the pyloroplasty and 7% in the pyloromyotomy group. Postoperative gastric emptying increased significantly in both groups (pyloroplasty group, from 18.1 +/- 3.1 to 49.5 +/- 7.9%, P = .0005; pyloromyotomy group, from 19.3 +/- 2.1 to 41.2 +/- 3.7%, P = .0001). There was no significant difference in the postoperative GES between the two groups (P = .289).
Both pyloroplasty and pyloromyotomy performed in conjunction with a fundoplication resulted in a significant increase in early postoperative gastric emptying. There was no advantage of pyloroplasty over pyloromyotomy during this follow-up period. These data suggest that pyloromyotomy is an effective gastric emptying procedure in children with GER and DGE.
胃食管反流（GER）患儿的胃排空延迟（DGE）常采用胃排空手术治疗。虽然幽门成形术是最常见的胃排空手术，但幽门肌切开术操作更简便，且发病率较低。本研究的目的是比较幽门肌切开术和幽门成形术在接受胃底折叠术的DGE和GER患儿中的疗效。
我们回顾了54例接受幽门肌切开术（n = 29）或幽门成形术（n = 25）并同时进行胃底折叠术的DGE患儿的病历。在术前和术后早期（术后6个月内）进行了锝99标记的硫胶体液相胃排空研究（GES）。正常胃排空定义为1小时时大于40%。比较了术后并发症发生率、再次胃底折叠术的发生率、术后住院时间以及术前和术后的GES。
幽门成形术组和幽门肌切开术组在年龄、性别、手术指征和神经状态方面具有可比性。两组术前GES无显著差异。与幽门成形术组（12例，48%，P = 0.10）相比，幽门肌切开术组（8例，28%）术后早期并发症（包括胃胀、伤口感染、肺炎、吞咽困难、肠梗阻和倾倒综合征）的发生率有下降趋势。幽门成形术组术后平均住院时间为10.6±1.4天，幽门肌切开术组为7.6±1.0天（P = 0.08）。再次胃底折叠术的发生率在幽门成形术组为8%，在幽门肌切开术组为7%。两组术后胃排空均显著增加（幽门成形术组，从18.1±3.1%增至49.5±7.9%，P = 0.0005；幽门肌切开术组，从19.3±2.1%增至41.2±3.7%，P = 0.0001）。两组术后GES无显著差异（P = 0.289）。
幽门成形术和幽门肌切开术联合胃底折叠术均使术后早期胃排空显著增加。在本随访期内，幽门成形术相对于幽门肌切开术并无优势。这些数据表明，幽门肌切开术是治疗GER和DGE患儿的一种有效的胃排空手术。
