小儿先天性巨结肠根治术式的决策评价  

Evaluation of the Selection of Operation Methods for 42 Cases of Common and Short Segment Hirschsprung′s Disease

作　　者：寿铁军[1] 文刚[1] 宋磊 陈金波 Shou Tiejun;Wen Gang;Song Lei(No.2 department of pediatric surgery,Ningbo Women and Children′Hospital,Zhejiang 315012,China)

机构地区：[1]宁波市妇女儿童医院,315012

出　　处：《医学研究杂志》2021年第12期99-102,共4页Journal of Medical Research

基　　金：浙江省医药卫生科技项目(2020372395)。

摘　　要：目的通过对先天性巨结肠患儿在两种经肛门拖出根治术后围术期及术后远期排便功能情况的比较分析,客观评价两种术式在治疗小儿常见型及短段型巨结肠的选择策略。方法将2015~2018年在笔者医院小儿普外科接受手术治疗的连续42例常见型及短段型先天性巨结肠患儿,按照根治术式不同分别纳入腹腔镜辅助下经肛Soave手术(LPT组,15例)组和经肛Soave手术(TEPT组,27例)组。获取患儿基本信息、围术期指标及当前排便功能和生活质量方面的资料,基于两种根治术式进行统计分析。结果两组间在手术时间和术后开始进食时间比较,差异有统计学意义,在术前洗肠天数、术中出血量、切除肠段长度、恢复正常饮食时间、抗生素使用时间、术后住院时间、术后平均大便频率、远期排便功能、远期生活质量等方面比较,差异无统计学意义。结论与TEPT患儿比较,LPT患儿围手术期及近远期的排便功能障与生活质量等方面无明显优势,而且手术时间及术后胃肠功能恢复更长,因此,在根治手术方式的决策方面需要客观评估,以达到精准施治和功能恢复的最佳预期。Objective Through analyzing the peri-operative index,long-term defecation function(DF)of children with Hirschsprung′s disease who had undergone two types of transanal pull-through surgery,to objectively evaluate the selection strategies for the two types of surgeries about the treatment of common and short-segment Hirschsprung′s disease.Methods From the year of 2015 to 2018,totally 42 cases with common and short-segment Hirschsprung′s disease were admitted in the general pediatric surgical department of our hospital.They were separately allocated into two groups:laparoscopic-assisted trans-anal soave operations(LPT,15cases)group and simply trans-anal soave operations(TEPT,27cases)group.All relative data were extracted,including baseline,peri-operative indexes,long-term DF and(quality of life)QoL conditions,whichwere analyzed between two groups.Results The result showed that there were statistically significant difference between two groups on operation duration and post-operation first feeding.While there were not statistically different on other indexes including pre-operation enema,bleeding in operation,length of removed intestine,normal feeding recovery time,duration of antibiotics agents,postoperative hospital stay,postoperative mean defecation frequency,long-term DF and QoL.Conclusion Compared with pure transanal pull-out,laparoscopic assisted radical surgery for Hirschsprung′s disease has no obvious advantages in terms of defecation dysfunction and quality of life in perioperative period,short-term and long-term outcomes.Moreover,the operation time and postoperative recovery of gastrointestinal function are much longer.Therefore,objective evaluation is necessary in the decision-making of radical surgery,in order to achieve the best expectation of precise treatment and functional recovery.

关 键 词：先天性巨结肠 经肛门 拖出术 腹腔镜辅助 排便功能 生活质量 

分 类 号：R72[医药卫生—儿科]