腹腔镜或机器人辅助Duhamel拖出术后留置肛管时间对巨结肠患儿术后恢复的影响  

The effect of laparoscopic or robotic-assisted Duhamel pull-through procedure postoperative rectal tube indwelling time on recovery of children

作　　者：孔德建 李帅[2] 曹国庆[2] 张茜 罗智彬 汤绍涛[2] KONG Dejian;LI Shuai;CAO Guoqing;ZHANG Xi;LUO Zhibin;TANG Shaotao(Department of Pediatric General Surgery,Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning 530005,China)

机构地区：[1]广西壮族自治区妇幼保健院小儿普外科,南宁530005 [2]华中科技大学同济医学院附属协和医院小儿外科

出　　处：《临床外科杂志》2023年第7期690-693,共4页Journal of Clinical Surgery

摘　　要：目的探讨长段型先天性巨结肠及肠神经节细胞发育不良患儿行腹腔镜或机器人辅助Duhamel拖出术后留置肛管不同时间对术后恢复的影响。方法2019年1月~2021年12月29例长段型巨结肠,56例肠神经节细胞发育不良保守治疗无效行微创肛门外横断直肠Duhamel拖出术,术后常规留置肛管,根据实际留置肛管时间的不同分为三组:A组,置管时间≤3天,8例;B组,置管时间4~6天,15例;C组,置管时间≥7天,62例。比较术中及术后疗效。结果三组病例在术后1年内小肠结肠炎发生次数、术后腹胀、肛周不适的发生率比较差异有统计学意义(P<0.05)。结论先天性巨结肠长段型及肠神经节细胞发育不良患儿行微创肛门外横断直肠的Duhamel拖出术后留置肛管时间长,有利于减少术后腹胀、肛周不适及小肠结肠炎的发生率。Objective To explore the effect of laparoscopic or robotic-assisted Duhamel pull-through procedure postoperative rectal tube indwelling time on recovery of children with long segment Hirschsprung disease(HD)and intestinal neuronal dysplasia(IND-B).Method The clinical data of 29 cases with long segment HD and 56 cases with IND-B failed to conservative treatment,received minimallly invasive external anal transection rectum Duhamel pull-through procedure from January,2019 to December,2021 were retrospectively analyzed.Postoperative routine indwelling rectal tube.According to actual rectal tube indwelling time,the patients were divided into 3 groups to analyzed:Group A,catheterization time≤3 days,8 cases;Group B,catheterization time 4-6 days,15 cases;Group C,catheterization time≥7 days,62 cases,and compared intraoperative and postoperative clinical data.Result There were statistical differences among three groups in terms of the incidence of enterocolitis occured within 1 year after surgery,postoperative abdominal distension and perianal discomfort(P<0.05).Conclusion In children with long segment Hirschsprung disease(HD)and intestinal neuronal dysplasia(IND-B),longer rectal tube indwelling time after minimallly invasive external anal transection rectum Duhamel pull-through procedure,which is beneficial to reduce the incidence of postoperative abdominal distention and perianal discomfort and enterocolitis.

关 键 词：先天性巨结肠 肠神经节细胞发育不良 Duhamel拖出术 肛管 术后恢复 

分 类 号：R726.5[医药卫生—儿科]