Hulka F, Harrison M W, Campbell T J, Campbell J R
Department of Surgery, School of Medicine, Oregon Health Sciences University, Emanuel Hospital and Health Center, Portland 97201, USA.
Am J Surg. 1997 May;173(5):450-2. doi: 10.1016/S0002-9610(97)00075-5.
Few references exist regarding contemporary complications of pyloromyotomy (PM) for infantile hypertrophic pyloric stenosis (IHPS). Therefore, we reviewed the frequency and outcome of patients with IHPS who developed complications from PM.
A 25-year retrospective review was performed in two populations. The first group included all infants who had a PM for IHPS at two pediatric surgery centers. The second group included all infants referred from other institutions who developed complications following PM for IHPS.
Between 1969 and 1994, 901 PMs were performed. Intraoperative complications occurred in 40 patients (4%), including 39 duodenal perforations and 1 difficult intubation requiring prolonged ventilation. No unrecognized duodenal perforations or incomplete PMs were found. Postoperative complications developed in 52 patients (6%). The wound infection rate was less than 1%. Postoperative vomiting occurred in 31 infants (3%). The mortality rate was 0.1%, with 1 death due to sepsis from delayed diagnosis of Hirschsprung's disease. During the same study period, 11 patients were referred from other hospitals for postoperative complications. Five had persistent vomiting treated successfully with expectant management. Six infants needed reoperation: 3 for persistent IHPS, 1 for gastric outlet obstruction, and 1 for small bowel obstruction secondary to adhesions; 1 required wound abscess drainage.
Pyloromyotomy is not without complications. Duodenal perforation should be infrequent, but when it occurs, it can usually be readily recognized and treated with minimal morbidity. Postoperative vomiting can be managed nonoperatively, but if it persists longer than 5 days, radiologic evaluation should be performed. Incomplete PM is uncommon and should not occur. A second myotomy is needed when the diagnosis of incomplete myotomy is established. A single standard of care should be expected of all surgeons who perform PM for IHPS.
关于婴儿肥厚性幽门狭窄（IHPS）行幽门肌切开术（PM）的当代并发症的参考资料很少。因此，我们回顾了因PM发生并发症的IHPS患者的发生率及转归情况。
对两组人群进行了为期25年的回顾性研究。第一组包括在两个儿科手术中心因IHPS行PM的所有婴儿。第二组包括从其他机构转诊来的、因IHPS行PM后发生并发症的所有婴儿。
1969年至1994年期间，共进行了901例PM。40例患者（4%）发生术中并发症，包括39例十二指肠穿孔和1例需要长时间通气的困难插管。未发现未被识别的十二指肠穿孔或不完全性PM。52例患者（6%）发生术后并发症。伤口感染率低于1%。31例婴儿（3%）术后出现呕吐。死亡率为0.1%，1例因先天性巨结肠延迟诊断导致败血症死亡。在同一研究期间，11例患者因术后并发症从其他医院转诊而来。5例持续性呕吐患者经保守治疗成功。6例婴儿需要再次手术：3例因持续性IHPS，1例因胃出口梗阻，1例因粘连继发小肠梗阻；1例需要伤口脓肿引流。
幽门肌切开术并非没有并发症。十二指肠穿孔虽不常见，但一旦发生，通常很容易识别并以最小的发病率进行治疗。术后呕吐可采用非手术治疗，但如果持续超过5天，应进行影像学评估。不完全性PM不常见且不应发生。确诊为不完全性肌切开术时需要再次行肌切开术。所有为IHPS行PM的外科医生都应遵循单一的治疗标准。
