经肛门腹腔镜手术治疗先天性巨结肠的临床应用  

Transanal laparoscopic surgery in treatment of Hirschsprung disease

作　　者：张建安[1] 靳杯 王敏[1] ZHANG Jian-an;JIN Bei;WANG Min(Department of Pediatric Surgery,Handan Central Hospital,Handan 056002,China)

机构地区：[1]邯郸市中心医院小儿外科,河北邯郸056002

出　　处：《腹腔镜外科杂志》2023年第4期286-291,共6页Journal of Laparoscopic Surgery

摘　　要：目的:探讨经肛门腹腔镜手术治疗先天性巨结肠的手术疗效及对身心应激、预后的影响。方法:选取2017年1月至2022年1月收治的103例先天性巨结肠患儿,根据手术方案分为A组(n=52,经肛门行腹腔镜手术)与B组(n=51,行腹腔镜辅助巨结肠根治术)。两组均采取快速康复理念。统计两组围术期指标、并发症、肛门排便控制效果、手术前后改良耶鲁围术期焦虑量表、疼痛介质(前列腺素E 2、内啡肽、P物质)等。结果:A组手术时间、术前洗肠时间短于B组,术中出血量少于B组(P<0.05);进入手术室、麻醉诱导时、术后第1天,A组焦虑评分低于B组(P<0.05);术后第1天,A组血清前列腺素E 2、P物质水平低于B组,内啡肽水平高于B组(P<0.05);两组并发症发生率及术后6个月排便控制优良率差异无统计学意义(P>0.05)。结论:两种腹腔镜手术结合快速康复理念治疗先天性巨结肠的效果相当,其中经肛门腹腔镜手术可减少术中出血量,缩短手术时间,减轻身心应激反应。Objective:To investigate the efficacy,the effect on the physical and mental stress of patients and the prognosis of transanal laparoscopic surgery in Hirschsprung disease(HD).Methods:From Jan.2017 to Jan.2022,103 children with HD who u nderwent surgery were selected as the research objects and divided into group A(transanal laparoscopic surgery,n=52)and group B(laparoscopic-assisted radical megacolon resection,n=51)according to the difference of the children's surgical procedures.The c oncept of enhanced recovery after surgery was adopted in all subjects in this study.The perioperative indicators,complications,anal bowel control results and the modified Yale perioperative anxiety scale before and after the operation,pain mediators(prostaglandin E 2,β-endorphin,substance P)of the two groups were counted.Results:The operation time and the preoperative bowel washing time in group A were shorter than those in group B,and the intraoperative blood loss was less than that in group B(P<0.05).At the time point of entering the operating room,induction of anesthesia and the first day after operation,the scores of anxiety in group A were lower than those in group B(P<0.05).On the first day after operation,the serum levels of prostaglandin E 2 and substance P in the group A were lower than those in group B,and the level ofβ-endorphin in group A was higher than that in group B(P<0.05).There was no significant difference in the incidence of complications and the excellent and good rate of defecation control six months after surgery between the two groups(P>0.05).Conclusions:The two types of laparoscopic surgery combined with enhanced recovery after surgery have comparable results in the treatment of children with HD,and transanal laparoscopic surgery can reduce intraoperative bleeding,shorten operative time,and decrease physical and mental stress.

关 键 词：HIRSCHSPRUNG病 巨结肠根治术 腹腔镜检查 经肛门 术后加速康复 

分 类 号：R656.9[医药卫生—外科学]