经肛门Swenson术及Soave术治疗巨结肠临床效果分析  

Evaluation of Swenson and Soave procedures by transanal pull-through for children with hirschsprung＇sdisease

作　　者：许芝林[1] 王龙[1] 李琰[1] 赵铮[1] 安群[1] 王强[1] 史兴晔[1] 李超[1] 

机构地区：[1]哈尔滨医科大学第一临床医学院小儿外科,150001

出　　处：《中华小儿外科杂志》2012年第12期913-915,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨分析巨结肠经肛门改良Swenson术、经肛门Swenson术（即完整保留直肠肛管黏膜及肌层）及经肛门Soave术三种术式的临床效果及各种并发症的发生率。方法结合我科巨结肠经肛门行改良Swenson术505例经验，加上统计国内外文献巨结肠经肛门Swenson术456例及经肛门Soave术1443例的大宗病例，将其各种并发症加以统计并予以分析。结果 经肛门改良Swenson术的污粪发生率为0．6％、经肛门Swenson术为3．5％、经肛门Soave术为6．4％；吻合1：3狭窄的发生率分别是0．4％、0、2．1％；失禁发生率为0．2V00、0．4％、0．4％；结肠小肠炎发生率为1．2％、0．4％、7．2％；便秘复发率为1．2％、0．9％、4．1％。三种手术方式并发症数据进行3×2行列表X^2检验，两两比较分析，经肛门Swenson术组和改良Swenson术组组间总并发症发生率差异没有统计学意义（X^2=1．6546，P=0．1983）；而经肛门Soave术组与经肛门Swenson术组和改良Swenson术组的组间总并发症发生率差异均有统计学意义，分别为X^2=56．3752、P〈0．0001和X^2=78．1408、P〈0．0001。结论三种经肛门手术均降低了手术创伤，但经肛门改良Swenson术和经肛门Swenson术术后并发症较少，临床效果更好。Objective To analyze the clinical outcome of transanal Soave procedure, modified transanal Swenson procedure and transanal Swenson procedure for Hirschsprung＇s disease. Methods 505 patients with Hirschsprung＇s disease （HSRD） underwent modified Swenson operation by transanal pull-through in our institution. Taken together with domestic and oversea reports in literatures for HSRD patients, including transanal Soave procedure in 1443 patients and transanal Swenson procedure in 456 cases, we retrospectively summary the clinical outcome in them. Results The incidence of soi- ling was retrospectively 0. 6%, 3.5%,6. 38% in modified transanal Swenson procedure, transanal Swenson procedure and transanal Soave procedure. The incidence of anastomotic stricture in them was retrospectively 0. 4% ,0 and 2. 1%. The incidence of incontinence was retrospectively 0. 2%, 0. 4%, 0. 4%. The incidence of enterocolitis was retrospectively 1.2%, 0. 4%, 7. 2%. Recurrent constipa- tion was retrospectively seen 1.2%, 0. 88 % and 4. 1 % in three groups. The statistical analysis indica- ted that no difference could be noted between modified transanal Swenson procedure and transanal Swenson procedure （3（2 = 1. 6546,P = 0. 1983）, and both of these groups presents statistically differ- ences in contrast to transanal Soave procedure. Conclusions Three procedures can reduce the damage induced by operation. Although this, the modified transanal Swenson procedure and transanal Swen- son procedure bring satisfactory efficacy with less complications.

关 键 词：肛门 HIRSCHSPRUNG病 消化系统外科手术 

分 类 号：R726.5[医药卫生—儿科]