Luciani J L, Allal H, Polliotto S, Galais C, Galifer R B
Department of Visceral Pediatric Surgery (Pr Galifer), Lapeyronie Hospital, Montpellier, France.
Eur J Pediatr Surg. 1997 Apr;7(2):93-6. doi: 10.1055/s-2008-1071062.
From January 1986 to February 1994, 198 children were operated on for hypertrophic pyloric stenosis (HPS). Postoperative follow-up have been carried out in 194 cases. The children were divided into two groups: group A (n = 134; 69.1%): without any postoperative diet troubles (n = 52) or simple regurgitations (n = 82), and group B (n = 60; 30.9%) presenting more significant vomiting requiring medical treatment (n = 52) or a prolongation of parental nutrition (n = 8). A retrospective study of the different factors which can possibly explain this postoperative vomiting was carried out. The criteria having an influence are: the age (44.5 days in group A; 35.7 days in group B; (p < 0.001) the weight at the time of the operation (3921) g in group A; 3647 in group B; p = 0.01) the thickness of the pylorus at the pre-operative ultrasound scan (5.2 mm in group A; 47 in group B; p < 0.015). The other studied criteria (prematurity, birth weight, delay in diagnosis, weight loss, hydroelectrolytic abnormalities, surgical approach way-subcostal or umbilical-, surgical difficulties and operation duration) are not statistically significant. The young age (and therefore the low weight) at the time of the pyloromyotomy can easily explain the post-operative vomiting through the physiological immaturity of the lower sphincter of the esophagus. It is more paradoxical to note that these difficulties are all the more frequent because the pyloric tumor is less thick at the ultrasound scan. But this criterion is also directly related to the child's age (average thickness of 4.5 mm before the age of one month and 5.8 mm after the age of two months; p < 0.0001). These data suggest the importance of systematic medical treatment to prevent postoperative vomiting in high-risk children, in order to decrease hospital stay (4.14 days in group A; 5.20 days in group B; p < 0.0001).
1986年1月至1994年2月，198例儿童因肥厚性幽门狭窄（HPS）接受手术治疗。对其中194例进行了术后随访。将这些儿童分为两组：A组（n = 134；69.1%）：术后无饮食问题（n = 52）或仅有单纯反流（n = 82）；B组（n = 60；30.9%）：出现更严重的呕吐需要药物治疗（n = 52）或延长肠外营养时间（n = 8）。对可能解释这种术后呕吐的不同因素进行了回顾性研究。有影响的标准包括：年龄（A组44.5天；B组35.7天；p < 0.001）、手术时体重（A组3921g；B组3647g；p = 0.01）、术前超声检查时幽门厚度（A组5.2mm；B组4.7mm；p < 0.015）。其他研究标准（早产、出生体重、诊断延迟、体重减轻、水电解质异常、手术入路 - 肋缘下或脐部 - 、手术难度和手术时间）无统计学意义。幽门肌切开术时年龄小（因此体重低），通过食管下括约肌的生理不成熟很容易解释术后呕吐。更自相矛盾的是，这些困难更常见，因为超声检查时幽门肿瘤较薄。但该标准也与儿童年龄直接相关（1个月龄前平均厚度为4.5mm，2个月龄后为5.8mm；p < 0.0001）。这些数据表明，对高危儿童进行系统药物治疗以预防术后呕吐很重要，以便缩短住院时间（A组4.14天；B组5.20天；p < 0.0001）。
