功能性微创理念在先天性巨结肠患儿围手术期应用临床研究  

Clinical application of functional minimally invasive surgery for Hirschsprung's disease

作　　者：阿迪拉·阿不都萨拉木 王文静 朱天琦 熊晓峰[1] 贺颖 刘率斌 杨继鑫[1] 冯杰雄[1] Adila Abudusalamu;Wang Wenjing;Zhu Tianqi;Xiong Xiaofeng;He Ying;Liu Shuaibin;Yang Jixin;Feng Jiexiong(Department of Pediatric Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院小儿外科,武汉430030

出　　处：《临床小儿外科杂志》2024年第1期22-28,共7页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金项目(81401240);湖北省自然科学基金项目(2022CBF134);湖北省卫生健康委员会科研基金(WJ2021M107)

摘　　要：目的探讨功能性微创理念在先天性巨结肠患儿围手术期应用的可行性及临床效果。方法回顾性分析2019年3月至2023年3月于华中科技大学同济医学院附属同济医院采取心形吻合术治疗的先天性巨结肠患儿临床资料。共有82例先天性巨结肠患儿纳入研究,其中功能性微创(functional minimally invasive,FMI)组45例,非功能性微创(non-functional minimally invasive,non-FMI)组37例。FMI组中,男34例、女11例,手术年龄(1.31±0.96)岁;non-FMI组中,男28例、女9例,手术年龄(1.16±0.63)岁。比较两组患儿术后首次经口喂养时间、首次排便时间、住院时间、肛管拔出时间、疼痛评分、并发症等方面的差异。两独立样本t检验用于服从正态分布连续变量的差异性检验,Mann-Whitney U检验用于非正态分布连续变量的差异性检验;分类变量采用卡方精确检验。结果与non-FMI组相比,FMI组术后拔出肛管的时间[(9.23±1.47)d比(11.50±1.91)d,P=0.001]和首次开始肠内营养的时间明显缩短[(36.92±19.01)h比(56.76±17.22)h,P=0.005],术后6个月总体并发症发生率明显降低(P=0.038),术后苏醒时及术后24 h疼痛评分均明显降低(P<0.001)。术后6个月复查两组肛门功能量化评分均升高,且两组升高差异有统计学意义(P<0.05)。而两组术后首次排便时间[(27.74±13.95)h比(28.91±12.61)h,P=0.937]、住院时间[(11.56±4.18)d比(13.19±3.67)d,P=0.473]及住院费用[(43087.23±4729.14)元比(62036.34±3129.77)元,P=0.312]比较,差异均无统计学意义(P>0.05)。结论功能性微创理念应用于先天性巨结肠的手术治疗是有效和安全的,可促进患儿术后康复,减轻术后疼痛,减少由于留置引流产生的不适,减少术后并发症的发生。Objective To explore the feasibility and clinical efficacy of functional minimally invasive(FMI)concept in perioperative management of children with Hirschsprung's disease(HSCR).Methods From March 2019 to March 2023,the relevant clinical data were retrospectively reviewed for 82 HSCR children undergoing heart-shaped laparoscopic anastomosis.They were assigned into two groups of FMI(n=45)and non-FMI(n=37).The former group was composed of 34 boys and 11 girls with a mean age of(1.31±0.96)years while the latter group had 28 boys and 9 girls with a mean age of(1.16±0.63)years.The differences of initial oral feeding timing,initial time of postoperative defecation,postoperative length of stay,postoperative timing of anal tube extraction,pain assessment and postoperative complications were compared between two groups.The measurement data were expressed as±s.Independent sample t test was utilized for examining the difference of continuous variables in a normal distribution and Mann-Whitney U test for variables in a abnormal contribution.Categorical variables were compared by Chi-square analysis or Fisher's exact test.Results In comparison with non-FMI group,FMI group had a significantly shorter time for postoperative removal of anal tube[(9.23±1.47)vs.(11.50±1.91)day,P=0.001].Time to initial postoperative oral feeding[(36.92±19.01)vs.(56.76±17.22)h,P=0.005]was significantly shorter.The incidence of postoperative complications declined markedly(P=0.038).Pain scores at 0/24 h post-operation dropped obviously in FMI group as compared with non-FMI group(P<0.05).Krickenbeck scores of anal function spiked in both groups at Month 6 post-operation and the inter-group difference was statistically significant(P<0.05).Initial time of postoperative defecation[(27.74±13.95)h vs.(28.91±12.61)h,P=0.937],length of hospitalization stay[(11.56±4.18)h vs.(13.19±3.67)day,P=0.473]and hospital expenses[(43087.23±4729.14)yuan vs.(62036.34±3129.77)yuan,P=0.312]were compared and the differences were not statistically significant.Con

关 键 词：先天性巨结肠 功能性微创 腹腔镜 外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]