经自然腔道与常规腹腔镜辅助先天性巨结肠根治术的对比研究  

A clinical comparative study of natural orifices transluminal endoscopic surgery and conventional lapa-roscoDy for I-Iirschsprun~＇ s Disease

作　　者：孙驰[1] 李索林[1] 刘扬[1] 于增文[1] 徐伟立[1] 

机构地区：[1]河北医科大学第二医院小儿外科,河北省石家庄市050000

出　　处：《临床小儿外科杂志》2013年第1期11-14,共4页Journal of Clinical Pediatric Surgery

基　　金：河北省医学适用技术跟踪项目（编号GL2010-14）资助

摘　　要：目的探讨经自然腔道内镜先天性巨结肠根治术的临床疗效。方法2009～2012年在本院接受腹腔镜辅助经肛门直肠拖出HD根治术的5岁以下患儿79例，其中常规腹腔镜辅助手术41例，经自然腔道辅助手术38例，按肠管切除范围分为直肠乙状结肠切除组和次全结肠切除组，分别记录各组病例手术数据及术后恢复情况，并进行统计学分析。结果常规腹腔镜辅助直肠乙状结肠切除30例和次全结肠切除11例，经自然腔道腹腔镜辅助直肠乙状结肠切除28例和次全结肠切除10例。所有手术均顺利完成。常规腹腔镜直肠乙状结肠切除手术时间（127．5±52．5）min，估计出血（22．8±22．4）mL，术后肠功能恢复时问（1．4±0．6）d；次全结肠切除手术时间（199．6．4±47．6）min，估计术中出血（28．6±19．2）mL，术后肠功能恢复时间（1．6±0．9）d。经自然腔道腹腔镜直肠乙状结肠切除手术时间（112．3±51．8）min，估计出血（17．3±8．3）mL，术后肠功能恢复时间（1．3±0．8）d；次全结肠切除手术时间（183．0±42．4）min，估计术中出血（23．0±7．9）mL，术后肠功能恢复时间（1．6±0．7）d。两种手术方式完成直肠乙状结肠切除术和次全结肠切除术的手术时间、术中出血量、术后肠蠕动功能恢复及并发症无差别。67例获随访，排便功能随术后时间延长而逐渐恢复，两种术式相比在各时段排便功能均无明显差异。结论经自然腔道腹腔镜HD根治术与常规腹腔镜手术相比，具有同样的手术效果，安全可靠，可进一步减少腹壁创伤，美容效果更佳。Objetive To explore the clinical outcomes of natural orifices transluminal endoscopic sur- gery（NOTES） for Hirschsprung＇s Disease（HD）. Methords From 2009 to 2012, 79 children with HD under- went laparoscopically assisted transanal endorectal pull-through under the age of 5 years, including 41 cases by the conventional laparoscopy（CL） and 38 cases by NOTES. Each manner was divided into the proctosigmoid- ectomy and subtotal colectomy according to the colon resected extent. Their operative time （ OT）, estimated blood loss（EBL）, blow resuscitation （BR） and postoperative complications were compared and analyzed be- tween the equivalent groups. Results There were 30 proctosigmoidectomies [ OT （ 127.5 ± 52.5 ） min, EBL （ 32.8 ± 22.4） mL and BR （ 1.4 ±0.6） d ] and 11 subtotal colectomies [ OT （ 199.6 ± 47.6） min, EBL （ 38.6 ±19.2）mL and BR（1.6 ±0.9）d] by CL. There were 28 proctosigmoidectomies OT（112.3 ±51.8）min, EBL （17.3 ±8.3）mL and BR（1.3 20.8）d and 10 subtotal coiectomies[ OT （183.0 ±42.4） min, EBL（23.0 ±7.9） mL and BR（ 1.6 ± 0.7）d ] by NOTES. All of procedures were successfully performed without intraopera- tive complications. Two approaches have similar operative time, blood loss and blow resuscitation. During a follow-up of 1 month to 4 years with 67 patients, the fecal function progressed postoperatively. Conclusions The NOTES for HD has the analogous operative outcomes comparing with CL. NOTES can further reduce the injuries of the abdominal wall and has better cosmetic results.

关 键 词：HIRSCHSPRUNG病 结直肠外科手术 腹腔镜检查 病例对照研究 

分 类 号：R656.9[医药卫生—外科学]