微创手术与经肛门Soave术治疗先天性巨结肠的个性化选择  

Individual-based treatment of hirschsprung＇s disease with transanal soave and minimally invasive surgery

作　　者：段祥升 牟亚汝[2] 宋亚宁[3] 张新玲 魏代香 李爱武[5] 

机构地区：[1]山东省日照市东港区人民医院小儿外科,山东省日照市276800 [2]山东大学附属省立医院心内科 [3]潍坊市中医院 [4]青州市人民医院五里分院 [5]山东大学齐鲁医院小儿外科

出　　处：《临床小儿外科杂志》2014年第1期3-5,9,共4页Journal of Clinical Pediatric Surgery

摘　　要：目的 根据病情选择单纯改良经肛门Soave术、辅助小切口手术或辅助腹腔镜手术对先天性巨结肠进行个性化治疗,并评价其安全性和有效性.方法 2002年1月至2010年12月,对137例先天性巨结肠患儿采用改良一期经肛门Soave术（Ⅰ组）,并根据年龄、影像学检查、病变类型选择个性化手术方案,其中单纯经肛门手术81例（ⅠA组）,辅助左下腹皮横纹小切口手术13例（ⅠB组）,腹腔镜辅助手术43例（ⅠC组）.并与1999年1月至2001年12月间112例（Ⅱ组）实施传统经肛门Soave术的患儿进行比较,其中单纯经肛门手术87例（ⅡA组）,开腹辅助手术35例（ⅡB组）.统计学分析采用两样本t检验、卡方检验以及Fisher检验,P＜0.05为差异有统计学意义.结果 ①Ⅰ组和Ⅱ组患儿术前临床资料相似,差异无统计学意义.②与ⅡA组相比,ⅠA组术后恢复快,并发症少,肛门功能恢复好.③与ⅡB组相比,ⅠB与ⅠC组术后并发症少,肛门功能恢复好,而ⅠB与ⅠC组无差异.结论 根据不同病情个性化选择单纯改良经肛门Soave术、辅助小切口手术或辅助腹腔镜手术,可有效减少手术并发症,提高生活质量.Objetive This study aimed to evaluate the superiority of personalized operative methods combined with a modified transanal Soave pull-through procedure （MTSPP） in the treatment of Hirschsprung＇s Disease （HSCR） in children.Methods From January 2002 to December 2012,137 patients （Ⅰ Group） with HSCR underwent personalized operative methods combined with MTSPP,including 81 patients treated with complete transanal procedure （Ⅰ A Group）,13 patients treated with transanal procedure combined with minilaparotomy （Ⅰ B Group） and 43 patients treated with transanal procedure combined with laparoscopy （Ⅰ C Group）.Patient history and follow-up data were collected and compared with those from 112 HSCR patients （ⅡGroup） treated with traditional transanal Soave pull-through procedure from January 1999 to December 2001,including 87 patients treated with complete transanal procedure （Ⅱ A Group） and 35 patients treated with transanal procedure combined with open surgery （Ⅱ B Group）.Statistical comparison was made with unpaired t tests,x2 tests and Fisher tests,with P value less than 0.05 were considered significant.Results ①Patients preoperative data were similar between Ⅰ Group and Ⅱ Group.②Compared with Ⅱ A Group,Ⅰ A Group had a rapid postoperative recovery and a better anal function recovering.③Compared Ⅰ B,Ⅰ C and ⅡB Group,Ⅱ B Group had the highest rate of postoperative complications and the worst anal function recovering.Ⅰ B Group was similar with Ⅰ C Group.Conclusions Personalized operative methods combined with MTSPP have great significance of decreasing complications,improving anal function and life quality for the treatment of HSCR

关 键 词：外科手术 微创性 HIRSCHSPRUNG病 肛门 

分 类 号：R656.9[医药卫生—外科学]