腹腔镜结肠次全切除联合改良Duhamel术治疗成人先天性巨结肠25例报告  

Laparoscopic subtotal resection of the colon combined with modified Duhamel for the treatment of adultHirschsprung'sdisease:reportof25cases

作　　者：夏凯 高仁元 吴小材 阮瑜 孙静[1] 俞明霞[1] 尹路 陈春球[1] Xia Kai;Gao Renyuan;Wu Xiaocai;Ruan Yu;Sun Jing;Yu Mingxia;Yin Lu;Chen Chunqiu(Diagnostic and Treatment Center for Refractory Diseases of Abdomen Surgery,Shanghai 200072,China;Operation Room,Shanghai Tenth People's Hospital,Shanghai 200072,China)

机构地区：[1]上海市第十人民医院腹部外科疑难诊治中心,上海200072 [2]上海市第十人民医院手术室,上海200072

出　　处：《中华普外科手术学杂志（电子版）》2023年第1期91-94,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目目的按探讨腹腔镜结肠次全切除联合改良Duhamel术治疗成人先天性巨结肠的围手术期情况及临床应用价值。方法法回顾性分析2019年6月至2021年12月接受腹腔镜结肠次全切除联合改良Duhamel术的25例成人先天性巨结肠患者资料。应用SPSS25.0软件进行统计分析。符合正态分布的计数资料以(x士s)进行描述,不符合正态分布的资料采用中位数进行描述。分析患者围手术期指标、并发症及术后肛门功能等。结果25例患者的中位年龄为42岁(18~68岁),中位住院时间为18d(11~54d),其中1例为普通型巨结肠,24例为长段型巨结肠。中位手术时间为4.5h(2~7.5h),中位术中出血量为150ml(100~600ml)。中位术后首次下床活动时间为3d(2~6d),平均术后禁食时间为(4.9±0.3)d。有3例患者发生围手术期并发症,包括肠梗阻、肠瘘、腹腔及骶尾部脓肿等。在术前3d、术后1个月、3个月对患者肛门功能进行评估,总优良率分别为32%、84%及96%。结论腹腔镜结肠次全切除联合改良Duhamel术对于成人先天性巨结肠的治疗是安全有效的,值得在临床实践中推广与应用。Objective To investigate the perioperative status and clinical value of laparoscopic subtotal colectomy combined with modified Duhamel in the treatment of adult Hirschsprung's disease.MethodsThe data of 25 adult patients with Hirschsprung's disease who underwent laparoscopic subtotal colon resection combined with modified Duhamel from June 2019 to December 2021 were retrospectively analyzed.SPSS 25.0 software was used for statistical analysis.Count data conforming to normal distribution were described by(x±s)deviation,while data not conforming to normal distribution were described by median.Perioperative indexes,complications and postoperative anal function were analyzed.ResultsThe median age of the 25 patients was 42 years old(18~68 years old),and the median length of hospital stay was 18 days(11~54 days).Among the 25 patients,1 case had common megacolon and 24 cases had long segmental megacolon.The median operative time was 4.5h(2~7.5 h),and the median intraoperative blood loss was 150 ml(100~600 ml).The median time of first postoperative activity was 3d(2~6 d),and the mean postoperative fasting time was(4.9+0.3)d.Three patients had perioperative complications,including intestinal obstruction,intestinal fistula,abdominal cavity and sacral tail abscess,etc.Anal function was evaluated at 3 days before surgery,1 month and 3 months after surgery,and the overall good rate was 32%,84%and 96%,respectively.Conclusion Laparoscopic colonic subtotal resection combined with modified Duhamel surgery is safe and effective in the treatment of adult Hirschsprung's disease,and worthy of promotion and application in clinical practice.

关 键 词：先天性巨结肠 改良DUHAMEL术 围手术期 治疗结果 

分 类 号：R735[医药卫生—肿瘤]