腹腔镜辅助Soave根治术治疗小儿先天性巨结肠的手术并发症及防治措施  

Complications and their prevention and treatment of laparoscopic-assisted Soave radical operation in the treatment of congenital megacolon in child

作　　者：石群峰[1] 李新宁[1] 

机构地区：[1]广西壮族自治区妇幼保健院儿童医院,广西南宁530003

出　　处：《腹腔镜外科杂志》2013年第3期177-182,共6页Journal of Laparoscopic Surgery

基　　金：广西壮族自治区科学技术厅广西科学基金项目(编号:桂科自0991181)

摘　　要：目的:探讨腹腔镜辅助Soave根治术治疗小儿先天性巨结肠的手术并发症及防治措施。方法:回顾分析2002～2012年为625例先天性巨结肠患儿行腹腔镜辅助Soave根治术的临床资料。其中男506例,女119例;9天～8岁3个月,平均(41.13±4.85)个月;体重2.3～23.4 kg,平均(8.34±0.86)kg。常见型334例,长段型216例,全结肠型75例。结果:625手术均获成功,手术时间70～210 min,平均(102.76±16.43)min;术中出血量3～10 ml,平均(4.58±0.62)ml。术后近期大便4～15次/d,6～12个月后大便接近正常,大便2～5次/d。术后发生小肠结肠炎56例(8.96%),肛周皮炎98例(15.68%),污粪35例(5.6%),便秘复发4例(0.64%),吻合口漏、结肠回缩3例(0.48%),结肠扭转4例(0.64%),肛门狭窄8例(1.28%),吻合口出血5例(0.8%)。结论:腹腔镜辅助Soave根治术治疗小儿先天性巨结肠具有创伤小、操作简单、安全、有效、美观等优点;但也具有一些并发症,尤其长段型、全结肠型巨结肠。术前诊断及术中、术后规范处理,可减少术后并发症的发生。Objective ： To investigate the complications and their prevention and treatment of laparoscopie-assisted Soave radical operation in the treatment of congenital megacolon in childl Methods ： The clinical data of 625 children （ male ： 506, female ： 119 ） who suffered from congenital megacolon and underwent laparoscopic-assisted S0ave radical operation were retrospectively analyzed. Their mean age was （41.13 ± 4.85 ） months （ range 9 d to 8 years and 3 months ） . their mean body weight was （ 8.34 ± 0.86 ） kg （ range 2.3±23.4 kg）- There were 334 cases of common type ;216 cases of long type, and 75 cases of total colonic type. Results ： All the 625 op- erations were successful, the mean operative time was （102.76 ＋ 16.43 ） min （range 70-210 minl. The mean blood loss was （4.58 ± 0.62） ml （range 3-10 ml）. The frequency of defecation shortly after the operation was 4-15 times per day.defecation was ahnost normal 6-12 months later, and its frequency was 2-5 times per day. Postoperative complications included 56 cases （ 8.96% ） of enterocolitis ,98 cases （15. 68% ） of perianal dermatitis, 35 cases （5.6%） of excrement. 4 cases （ 0. 64% ） of recurrent constipation. 3 cases （0.48%） of anastomotic fistula and colon retraction＇,4 cases （0.64%） of sigmoid volvnlus,8 cases （1.28%） of anal stenosis and 5 eases （0.8%） of anastomotic bleeding. Conclusions： Laparoscopic-assisted Soave radical operation m the treatment ＇of congenital megacolon in child is mini-invasive, easy, safe, effective and has better cosmetic result. There are still some complications, especially the long type and total colonic type. Preoperative diagnosis ,intraoperative and postoperative standardized processing can reduce the postop- erative complications.

关 键 词：HIRSCHSPRUNG病 SOAVE根治术 腹腔镜检查 儿童 手术后并发症 防治 

分 类 号：R726.5[医药卫生—儿科]