先天性巨结肠患儿术后住院时间影响因素分析  

Influencing factors of postoperative hospital stay of children with Hirschsprung disease

作　　者：朱天琦[1] 孙晓毅[1] 魏明发[1] 蒙信尧 冯杰雄[1] Zhu Tianqi;Sun Xiaoyi;Wei Mingfa;Meng Xinyao;Feng Jiexiong(Department of Pediatric Surgery,Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology)

机构地区：[1]华中科技大学同济医学院附属同济医院小儿外科,武汉430000

出　　处：《中华妇幼临床医学杂志（电子版）》2021年第1期106-113,共8页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家自然科学基金项目(81700448)。

摘　　要：目的探讨先天性巨结肠(HD)患儿术后住院时间影响因素。方法选择2011年6月至2018年6月,于华中科技大学同济医学院附属同济医院进行HD经典开腹术、腹腔镜辅助下拖出术(LAPT)、单纯经肛门拖出术(TERPT)等HD一期根治术治疗的301例HD患儿为研究对象。其中,短段型、常见型、长段型HD患儿分别为110、152、39例。采用回顾性研究方法,收集所有患儿的临床病例资料。采用单因素及多因素Cox比例风险回归分析方法,对短段型、常见型、长段型HD患儿术后住院时间影响因素进行分析。本研究遵循的程序符合华中科技大学同济医学院附属同济医院伦理委员会制定的伦理学标准,得到该委员会批准[审批文号:2019伦审字(S108)号]。结果①本研究301例HD患儿中,左半结肠切除术与次全结肠切除术者分别为198例(65.8%)与103例(34.2%),手术吻合方式为近端结肠与远端直肠端-端吻合与斜面吻合者分别为201例(66.8%)与100例(33.2%)。术后30例(10.0%)发生并发症患儿中,12例为吻合口相关并发症,6例为伤口感染,2例为HD相关性小肠结肠炎(HAEC),10例为肠黏连、肠系膜裂孔疝、盆腔感染等。②本研究301例HD患儿术后住院时间为(12.9±4.1)d。其中,短段型、常见型、长段型HD患儿术后住院时间分别为(13.4±4.4)d、(12.2±3.6)d与(14.6±3.2)d,3者比较,差异有统计学意义(F=6.960、P=0.016)。③HD患儿术后住院时间影响因素的Cox比例风险回归分析结果显示,短段型与长段型HD患儿术后住院时间的独立影响因素均为术后并发症(HR=0.126,95%CI:0.029~0.532,P=0.005;HR=0.123,95%CI:0.028~0.535,P=0.005);而常见型HD患儿术后住院时间的独立影响因素为手术时间及术后并发症(HR=0.997、0.213,95%CI:0.995~0.999、0.034~0.412,P=0.037、0.013)。结论术后并发症是短段型、常见型、长段型HD患儿术后住院时间的独立影响因素,而对于常见型HD患儿,手术时间亦是其术后住院�Objective To explore influencing factors of postoperativehospital stay of children with Hirschsprung disease(HD).Methods From June 2011 to June 2018,a total of 301 cases of HD children undergoing HD classic laparotomy,laparoscopic-assisted pull-through operation(LAPT),and transanal endorectal pull-through operation(TERPT)one-stage radical HD operation in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were selected as research subjects.Among them,there were 110 children with short-segment HD,152 children with common type HD and 39 children with long-segment HD,respectively.Clinical cases data of all children were collected by retrospective research methods.Univariate and multivariate Cox proportional hazard analysis methods were used to analyze the influencing factors of postoperative hospital stay in children with short-segment,common type and long-segment HD.This study was approved by the Ethics Committee of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology[Approval No.2019 ARB(S108)].Results①Among 301 children with HD in this study,198 cases(65.8%)underwent left hemicolectomy and 103 cases(34.2%)underwent subtotal colectomy;end-end anastomosis and side-side anastomosis of proximal colon and distal rectum were performed in 201 cases(66.8%)and 100 cases(33.2%),respectively.Among 30 children(10.0%)with complications after surgery,12 cases suffered of postoperative anastomosis-related complications,6 cases of wound infection,2 cases of HD associated enterocolitis(HAEC),10 cases of other complications,such as intestinal adhesion,mesenteric hiatal hernia,pelvic infection,etc..②Postoperative hospital stay of 301 children with HD was(12.9±4.1)d.Among them,postoperative hospital stay was(13.4±4.4)d in short-segment HD,(12.2±3.6)d in common type HD,and(14.6±3.2)d in long-segment HD,and the difference was statistically significant(F=6.960,P=0.016).③Cox proportional hazard analysis of postoperative hospital

关 键 词：HIRSCHSPRUNG病 住院时间 危险因素 手术后并发症 儿童 

分 类 号：R726.5[医药卫生—儿科]