新生儿巨结肠一期根治术时机的探讨  

Timing investigation of single-stage definitive surgery for newborn with Hirsehsprung＇s disease

作　　者：肖尚杰[1] 杨文熠[1] 原丽科 张颖[1] 宋涛[1] 许露[1] 田松[1] 葛午平[1] 周佳亮[1] 朱小春[1] 

机构地区：[1]广东省妇幼保健院新生儿外科,广州511400

出　　处：《中华胃肠外科杂志》2016年第10期1160-1164,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：广东省医学科研基金（B2013034）

摘　　要：目的前瞻性分析先天性巨结肠于出生3个月内行一期根治手术的疗效，探讨新生儿巨结肠一期根治术的时机。方法2013年3月至2015年9月间广东省妇幼保健院收治的35例常见型先天性巨结肠新生儿患者．按随机数字法分为3个月内治疗组（18例，于3个月龄内行巨结肠根治术）和3个月后治疗组（17例，先保守治疗一段时间后于3个月龄后再行巨结肠根治术）。两组均采用腹腔镜辅助下经肛门改良Soave巨结肠根治术（LATEP）进行治疗。比较两组患儿的围手术期情况、术后并发症发生情况、术后临床肛门功能（Wingspread评分法）及钡灌肠检查情况。结果两组基线资料的比较，差异无统计学意义（均P〉0．05），具有可比性。两组患儿均成功完成一期LATEP术，无中转开腹。与3个月后治疗组比较，3个月内治疗组患者的术前肠道准备时间和手术时间缩短[分别为（6．2±3．3）d比（9．3±4．1）d，P=0．042；（95±15）min比（121±23）min。P=0．029]，术中出血量减少[（13±3）ml比（22±5）ml，P=0．036]，切除肠管较短[（16．±5）cm比（23±8）cm，P=0．033]，术后胃肠功能恢复时间、静脉营养时间及住院时间缩短[分别为（2．3±0．5）d比（2．9±0．6）d，P=0．046；（5．1±2．1）d比（5．9±2．3）d，P=0．048；（12．9±3．3）d比（15．8±4．3）d，P=0．049]。两组均无吻合口瘘、夹层感染及腹腔感染等近期并发症的发生。随访2～24月，远期并发症中，仅肛周皮炎3个月内治疗组多于3个月后治疗组[50．0％（9／18）比23．5％（4／17），P=0．045]。术后6月和12月临床肛门功能评分显示，3个月内治疗组优良率分别为81.3％（13／16）和92．9％（13／14），3个月后治疗组分别为85．7％（12／14）和92．3％（12／13），两组问比较，差异均无统计学意义（均P〉0．05）。两组患儿术后6月和12月钡灌肠检查�Objective To investigate the operation timing of newborns with rectosigmoid Hirschsprung＇s disease （HD）. Methods From March 2013 to September 2015, 35 newborns diagnosed as rectosigmoid HD in our department were prospectively and randomly divided into 2 groups： less than 3 months treatment group （18 cases） and more than 3 months treatment group （17 cases, conservative treatment for 3 months）. They all underwent laparoscopic-assisted transanal endorectal pull-through （LATEP） （modified Soave） procedure. Clinical data, perioperative conditions, postoperative complication, postoperative anal function evaluated by Wingspread score and barium enema were compared between two groups. Results The baseline data of two groups were comparable （all P 〉 0.05）. All the cases completed single-stage LATEP procedure successfully without conversion to open operation. Compared with more than 3 months treatment group, preoperative bowel preparation time and operation time were significantly shorter [ （6.2 ± 3.3） vs. （9.3 ± 4.1 ） days, P = 0.042; （95 ± 15） vs.（121 ± 23） minutes, P = 0.029, respectively], intra-operative blood loss was significantly less [（13 ± 3） ml vs. （22 ± 5） ml, P = 0.036], length of resected bowel was significantly shorter [ （ 16 ± 5） cm vs. （23 ± 8） cm, P = 0.033 ], and bowel movement recovery time, parenteral nutrition time, hospital stay were also significantly shorter [（2.3 ±0.5）vs. （2.9 ± 0.6） days, P= 0.046; （5.1 ± 2.1） vs. （5.9 ± 2.3） days, P= 0.048; （12.9 ± 3.3） vs. （15.8 ± 4.3） days, P= 0.049, respectively] in less than 3 months treatment group. No short-term complications, such as anastomotic leak, interlayer infection and abdominal infection occurred in both groups. The follow- up period ranged from 2 months to 24 months. Only the incidence of perianal excoriation was significantly higher in less than 3 months treatment group compared with more than 3 months treatment group [50.0%（9/18） vs. 23.5%（4

关 键 词：先天性巨结肠 手术年龄 新生儿 巨结肠根治术 腹腔镜 

分 类 号：R726.5[医药卫生—儿科]