腹腔镜下辅助经肛门改良Soave术Ⅰ期治疗小儿先天性巨结肠的近期疗效及影响痊愈的危险因素分析  

Short-term Curative Effect of Laparoscope-Assisted One-Stage Transanal Modified Soave Operation in the Treatment of Children with Hirschsprung's Disease and Risk Factor Analysis

作　　者：徐沛 刘铭 XU Pei;LIU Ming(Department of Pediatric Surgery,the Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China)

机构地区：[1]西南医科大学附属医院小儿外科,四川泸州646000

出　　处：《解放军医药杂志》2021年第2期65-69,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：四川省卫生厅科研基金项目(20170191)。

摘　　要：目的探讨腹腔镜下辅助经肛门改良Soave术Ⅰ期治疗小儿先天性巨结肠近期疗效及影响痊愈的相关因素。方法回顾性分析2016年8月—2019年2月本院收治的92例先天性巨结肠患儿的临床资料,根据手术方法不同分为对照组44例和观察组48例,观察组给予腹腔镜下经肛门改良Soave术,对照组给予肛门改良Soave术。对比2组手术指标、近期疗效,分析影响患儿术后痊愈的相关因素。结果观察组手术时间、住院时间、胃肠功能恢复时间短于对照组,术中出血量少于对照组(P<0.01)。观察组术后并发症总发生率低于对照组(P<0.05)。观察组术后6、12个月肛门功能总优良率高于对照组(P<0.05)。吻合口狭窄、肠炎、腹胀是影响先天性巨结肠患儿术后近期痊愈的独立危险因素(P<0.05)。结论对先天性巨结肠患儿采用腹腔镜辅助下经肛门改良Soave术Ⅰ期治疗,可减少术后并发症,改善肛门功能。吻合口狭窄、合并肠炎、合并腹胀为影响患儿术后近期痊愈的独立危险因素。Objective To explore the short-term curative effect of laparoscope-assisted modified transanal one-stage Soave(TOS)procedure in the treatment of children with Hirschsprung's disease and related factors affecting the recovery.Methods The clinical data of 92 children with Hirschsprung's disease admitted to our hospital from August 2016 to February 2019 were retrospectively analyzed.According to different surgical methods,they were divided into control group(n=44)and observation group(n=48).The observation group was given laparoscope-assisted modified transanal Soave operation,and the control group was given modified transanal Soave operation.The operation indexes and short-term curative effect of the two groups were compared,and the related factors influencing the postoperative recovery of the children were analyzed.Results The duration of operation,length of hospitalization,gastrointestinal function recovery time of the observation group were significantly shorter than those of the control group,and the intraoperative blood loss was significantly less than that of the control group(P<0.01).The total incidence of postoperative complications in the observation group was significantly lower than that in the control group(P<0.05).The excellent and good rate of anal function in the observation group at 6 and 12 months after operation was significantly higher than that in the control group(P<0.05).Anastomotic stenosis,enteritis and abdominal distension were the independent risk factors for short-term recovery(P<0.05).Conclusion The laparoscope-assisted modified TOS procedure in the treatment of children with Hirschsprung's disease can reduce the incidence of postoperative complications and improve anal function.Anastomotic stenosis,enteritis,and abdominal distension are independent risk factors that affect the short-term recovery of children after surgery.

关 键 词：先天性巨结肠 腹腔镜 经肛门 改良Soave术Ⅰ期 儿童 肛门功能 危险因素 

分 类 号：R726.5[医药卫生—儿科]