腹腔镜辅助与常规开腹Soave’s术治疗患儿先天性长段型巨结肠的疗效对比  

Comparison of laparoscopic-assisted and open Soave’s operation for treatment of congenital long-segment Hirschsprung’s in infants

作　　者：李芊 张宏伟 刘丰丽 张建军 LI Qian;ZHANG Hong-wei;LIU Feng-li;ZHANG Jian-jun(Department of Neonatal Surgery,Xuzhou Children’s Hospital Affiliated to Xuzhou Medical University,Xuzhou 221000,Jiangsu,China;Department of General Surgery,Xuzhou Children’s Hospital Affiliated to Xuzhou Medical University,Xuzhou 221000,Jiangsu,China)

机构地区：[1]徐州医科大学附属徐州儿童医院新生儿外科,江苏徐州221000 [2]徐州医科大学附属徐州儿童医院普外科,江苏徐州221000

出　　处：《生物医学工程与临床》2023年第6期723-728,共6页Biomedical Engineering and Clinical Medicine

基　　金：徐州市科技局基金资助项目(KC21057)。

摘　　要：目的对比腹腔镜辅助Soave’s术和常规开腹Soave’s术治疗小婴儿先天性长段型巨结肠的临床疗效,旨在为此类患者选择治疗方案提供依据。方法回顾性分析2012年1月至2021年4月在徐州市儿童医院中心进行Soave’s术的先天性长段型巨结肠患儿102例,其中男性83例,女性19例;年龄11天~10个月,平均年龄3.08个月;体质量5.34~7.98 kg,平均体质量6.63 kg;出生体质量2.89~3.76 kg,平均出生体质量3.15 kg;5例患儿有家族史。根据手术方式分为观察组和对照组;观察组56例,行腹腔镜辅助Soave’s术;对照组46例,行常规开腹Soave’s术。记录所有患儿围手术期指标(手术时间、胃肠功能恢复时间、术中出血量、总住院时间等,以及术后留置导尿管时间)、术后肛门功能(包括Kelly评分、肛门静息压和肛管高压区长度的测量)、术后随访1年并记录并发症,对以上所有数据进行统计分析。结果与对照组对比,观察组手术时间显著缩短,出血量明显减少,总住院时间缩短,差异均有统计学意义(P<0.05);两组术后胃肠功能恢复速度、留置导尿时间比较,差异无统计学意义(P>0.05)。术后3个月所有患儿Kelly评分有所升高,且肛管高压区长度和肛门静息压力相比术前均有所提高,差异有统计学意义(P<0.05)。同时,治疗后观察组Kelly评分为(5.83±0.42)分,明显高于对照组(5.03分±0.63分);肛管高压区长度和肛门静息压分别为(2.26±0.29)cm、(53.63±7.53)mmHg,与对照组(2.13 cm±0.24 cm、50.72 mmHg±7.01 mmHg)相比,差异有统计学意义(P<0.05)。观察组并发症发生率小于对照组(23.21%vs 69.57%),差异有统计学意义(P<0.05)。结论在小婴儿长段型先天性巨结肠治疗中,腹腔镜辅助Soave’s术与常规开腹Soave’s术相比,在促进患儿术后恢复、肛门功能改善及减少术后并发症发生率等方面更具优势。Objective To compare the clinical efficacy of laparoscopic-assisted Soave’s operation and conventional open Soave’s operation in treatment of infantile congenital long-segment Hirschsprung’s disease,and provide basis for selection of different treatments.Methods From January 2012 to April 2021,102 congenital long segment megacolon infants underwent Soave’s operation were enrolled,which included 83 males and 19 females,aged 11 days-10 months with mean age of 3.08 months;body mass was 5.34-7.98 kg with mean body mass of 6.63 kg;birth body mass was 2.89-3.76 kg with mean birth body mass of 3.15 kg.Five patients had family history of disease.According to operation methods,all of them were divided into observation group(n=56,performed laparoscopic-assisted Soave’s operation)and control group(n=46,conventional open Soave’s operation).The perioperative indicators(operation time,gastrointestinal function recovery time,intraoperative bleeding volume,hospitalization time and post operative indwelling catheter time),postoperative anal function(Kelly score,length measurement of anal resting pressure and anal canal high pressure area),postoperative follow-up for 1 year and complications were recorded,and all data were statistically analyzed.Results Compared with control group,the operation time was significantly shortened,bleeding volume was significantly reduced and hospitalization time was reduced in observation group,and the differences were statistically significant(P<0.05).There were no significant difference in recovery rate of gastrointestinal function and indwelling catheterization time between 2 groups(P>0.05).Compared with before operation,the Kelly score of all patients were increased 3 months post operation,length of anal canal high pressure area and anal resting pressure were significantly improved(P<0.05).After treatment,Kelly score of observation group[(5.83±0.42)scores]was significantly higher than that of control group[(5.03±0.63)scores];length of anal canal high pressure area[(2.26±0.29)cm]and

关 键 词：先天性长段型巨结肠 Soave’s术 腹腔镜 肛门功能 

分 类 号：R726.5[医药卫生—儿科]