腹腔镜Soave术及Swenson术治疗短段型先天性巨结肠对控便功能的影响  

Effect of laparoscopic Soave and modified laparoscopic Swenson procedures on defecation control in patients with short-segment Hirschsprung’s disease

作　　者：田飞 郭朝[1] 魏强[1] Tian Fei;Guo Chao;Wei Qiang(The Second Department of General Surgery,Xi’an Children’s Hospital,Xi’an 710003,China)

机构地区：[1]西安市儿童医院普外二科,710003

出　　处：《中华普通外科学文献（电子版）》2020年第2期137-140,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜Soave术(LS)与改良腹腔镜Swenson术(MLSw)治疗短段型先天性巨结肠(HD)患儿的效果及对控便功能的影响。方法回顾性分析2012年1月至2017年12月西安市儿童医院手术治疗的短段型HD患儿90例,其中LS治疗45例(LS组),另外45例采用MLSw治疗(MLSw组)。对比两组患儿的围手术期指标,术后1年时检测患儿的肛肠压,Heikkinen评分法评价其控便功能。结果MLSw组的手术时间、术中出血量、术后进食时间、住院时间均少于LS组(t=6.718、15.583、2.183、3.343,均P<0.05)。术后1年时,MLSw组的肛管静息压、肛管高压带长度、最大收缩压、感觉阈值均低于LS组,排便次数、大便性状、污粪、需要治疗及Heikkinen总分均高于LS组,差异有统计学意义(P<0.05)。MLSw组术后并发症发生率为6.67%(3/45),显著低于LS组的22.22%(10/45),差异有统计学意义(χ^2=4.406,P=0.036)。结论MLSw治疗短段型HD患儿的效果优于LS,患者术后并发症发生率更低,控便功能更好。Objective To investigate the effect of laparoscopic Soave(LS)and modified laparoscopic Swenson(MLSw)on children with short-segment Hirschsprung’s disease(HD)and the effect on function control.Methods Data of ninety children with short-segment HD who underwent surgery from January 2012 to December 2017 in Xi’an Children’s Hospital were retrospectively analyzed,including 45 patients with LS(LS group)and 45 patients with MLSw(MLSw group).The perioperative indexes of the two groups were compared.The anorectal pressure of the children was detected at 1 year after operation,and the control function was evaluated by Heikkinen score.Results The operation time,intraoperative blood loss,postoperative feeding time and hospitalization time of MLSw group were significantly lower than those of LS group(t=6.718,15.583,2.183,3.343,all P<0.05).One year after operation,the anal canal resting pressure,anal canal pressure band,maximum systolic pressure,and sensory threshold in the MLSw group were lower than those in the LS group,while the number of bowel movement,stool characteristics,feces,need for treatment,and Heikkinen total score were higher,the differences were statistically significant(P<0.05).The postoperative complication rate was 6.67%(3/45)in the MLSw group,which was significantly lower than 22.22%(10/45)in the LS group,the difference was statistically significant(χ^2=4.406,P=0.036).Conclusion The effect of MLSw in the treatment of children with short-segment HD is better than LS,with lower operative complication rate and better postoperative function control.

关 键 词：HIRSCHSPRUNG病 结直肠外科手术 控便功能 腹腔镜 SOAVE术 Swenson术 短段型 

分 类 号：R656.9[医药卫生—外科学]