直肠分层活检术在儿童顽固性便秘中的应用探讨  

Application of stratified rectal biopsy for refractory constipation in children

作　　者：陶波圆 陈凯 曾纪晓 刘斐 徐晓钢 兰梦龙 梁子建 钟知足 林玉珍 林瑞燕 Tao Boyuan;Chen Kai;Zeng Jixiao;Liu Fei;Xu Xiaogang;Lan Menglong;Liang Zijian;Zhong Zhizu;Lin Yuzhen;Lin Ruiyan(Department of Gastrointestinal Surgery,Municipal Women&Children’s Medical Center,Guangzhou Medical University,National Children’s Regional Medical Center,Guangzhou 510120,China;Department of Pathology,Municipal Women&Children’s Medical Center,Guangzhou Medical University,National Children’s Regional Medical Center,Guangzhou 510120,China;Operating Room,Municipal Women&Children’s Medical Center,Guangzhou Medical University,National Children’s Regional Medical Center,Guangzhou 510120,China)

机构地区：[1]国家儿童区域医疗中心广州医科大学附属妇女儿童医疗中心胃肠外科,广州510120 [2]国家儿童区域医疗中心广州医科大学附属妇女儿童医疗中心病理科,广州510120 [3]国家儿童区域医疗中心广州医科大学附属妇女儿童医疗中心手术室,广州510120

出　　处：《临床小儿外科杂志》2024年第9期814-818,共5页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(82170528);广东省自然科学基金(2022A1515012254);广州市科技计划市校(院)联合资助项目(202201020612);广州市临床特色技术项目(2023C—TS48);卫生健康技术重点推广项目(XM202403895)。

摘　　要：目的介绍一种直肠全层活检的新方法, 并与传统方法进行对比, 以提高顽固性便秘儿童病理取材的达标率。方法 2019年12月至2022年12月广州医科大学附属妇女儿童医疗中心胃肠外科共收治顽固性便秘儿童269例, 根据纳入标准对其中217例进行回顾性分析。217例中, 采取传统直肠全层活检术92例(为传统组), 直肠分层活检术125例(为分层组)。对比分析两组基线资料、手术情况以及术中取材达标率。结果两组均顺利完成手术, 传统组与分层组手术年龄[(10.9±2.8)个月比(10.4±2.7)个月, t=1.400]、术中出血量[(4.6±1.9)mL比(5.1±1.7)mL, t=-1.875]、术后住院时间[(1.6±0.6)d比(1.7±0.5)d, t=-1.051]比较, 差异均无统计学意义(P>0.05);取材达标率[88.0%(81/92)比100%(125/125)]、手术时间[(29.3±6.6)min比(34.7±5.6)min, t=-6.525]比较, 差异均有统计学意义(P<0.05)。两组均无一例出现手术相关并发症。结论直肠分层活检术可以明显提高顽固性便秘儿童术中病理取材的达标率, 可避免因取材不足而导致病理诊断困难。Objective To introduce a novel method of rectal full thickness biopsy and compare it with traditional method to further improve the satisfaction of pathological sampling for refractory constipation(RC)in children.Methods From December 2019 to December 2022,a total of 269 RC children were hospitalized.According to the inclusion criteria,the relevant clinical data were retrospectively reviewed for 217 cases.Traditional full thickness rectal biopsy(traditional group,n=92)and stratified rectal biopsy(stratified group,n=125)were performed.Baseline profiles,intraoperative findings and compliance rate of pathological sampling were compared between two groups.Results All operations were completed successfully.Operative age[(10.9±2.8)vs.(10.4±2.7)month],volume of blood loss[(4.6±1.9)vs.(5.1±1.7)ml]and postoperative hospitalization stay[(1.6±0.6)vs.(1.7±0.5)day]showed no significant inter-group differences(P>0.05).Significant inter-group difference existed in compliance rate of sampling[88.0%(81/92)vs.100%(125/125)]and operative duration[(29.3±6.6)vs.(34.7±5.6)min](P<0.05).Conclusions Stratified rectal biopsy may significantly improve the compliance rate of sampling and avoid pathological diagnostic difficulties of insufficient sampling.

关 键 词：便秘 活组织检查 病理学 外科 儿童 

分 类 号：R73[医药卫生—肿瘤]