持续肛管排气排便在先天性巨结肠治疗中的应用  

Clinical application of continuous rectal tube drainage in the treatment of Hirschsprung disease

作　　者：丁宁[1] 成子衿 刘智文[1] Ding Ning;Cheng Ziqin;Liu Zhiwen(Department of Neonatal Surgery,Jiangxi Children's Hospital,Nanchang 330000,China)

机构地区：[1]江西省儿童医院新生儿外科,南昌330000

出　　处：《临床小儿外科杂志》2024年第11期1049-1053,共5页Journal of Clinical Pediatric Surgery

基　　金：江西省卫生健康委科技计划项目(202310997)。

摘　　要：目的探讨留置肛管持续排气排便在先天性巨结肠术前保守治疗期的应用价值。方法本研究为回顾性研究,将2019年1月至2023年1月江西省儿童医院新生儿外科收治的80例先天性巨结肠患儿纳入研究,按照术前保守治疗期辅助排便方式的不同,分为研究组(长期留置肛管)和对照组(行灌肠、扩肛)。根据先天性巨结肠分型,研究组分为常见型组(A组,n=21)和长段型组(C组,n=11),对照组亦分为常见型组(B组,n=33)和长段型组(D组,n=15)。将四个亚组配为两对(A组&B组/C组&D组),比较各组性别、出生体重、首次就诊日龄、行根治术时日龄、手术方式、先天性巨结肠相关小肠结肠炎发生率、肠造瘘率、行根治术时体重、手术时间、术中切除肠管长度、术后标本扩张段最大直径、病理标本肠壁炎症发生率、术后并发症、住院时间及住院费用等。结果研究组与对照组首次就诊日龄、出生体重、行根治术时日龄、性别、手术方式比较,差异均无统计学意义(P>0.05)。A、B两组肠造瘘发生率、根治术时体重、手术时间、切除肠管长度、病理标本肠壁炎症发生率、术后并发症、住院天数、住院费用差异无统计学意义(P>0.05)。C、D两组行根治术时体重、手术时间、切除肠管长度差异无统计学意义(P>0.05)。A组发生先天性巨结肠相关小肠结肠炎3例,B组14例;A组扩张段最大直径(3.00±0.59)cm,B组(3.77±0.64)cm;C组发生先天性巨结肠相关小肠结肠炎2例,D组9例;C组无一例肠造瘘病例,D组6例;C组扩张段最大直径(3.09±0.49)cm,D组(3.90±0.55)cm;C组病理标本见肠壁炎症1例,D组8例;C组术后发生并发症2例,D组10例;C组住院天数(32.73±6.37)d,D组(53.60±15.78)d;C组住院费用(53891.29±10317.25)元,D组(81400.33±27393.87)元;上述指标差异均有统计学意义(P<0.05)。结论新生儿及小婴儿先天性巨结肠患者行根治术前长期留置肛管可以降低术前先天ObjectiveTo explore the application value of continuous defecation through indwelling anal canal in the conservative treatment period prior to surgery for Hirschsprung disease in infants.MethodsThis retrospective study included 80 infants with Hirschsprung disease treated at the Department of Neonatal Surgery,Jiangxi Children's Hospital,from January 2019 to January 2023.Based on different methods of auxiliary defecation during the conservative treatment period,the infants were divided into a study group with long-term anal canal retention and a control group receiving enema and anal dilation.The study group was further divided into common type(Group A,n=21)and long segment type(Group C,n=11),while the control group was divided into common type(Group B,n=33)and long segment type(Group D,n=15).Compliance with tube placement was statistically analyzed.The four subgroups were paired for comparison(A&B/C&D)regarding gender,birth weight,age at first visit,age at definitive surgery,surgical method,incidence of small intestine-colonitis related to Hirschsprung disease,rate of colostomy,weight at definitive surgery,duration of surgery,length of resected bowel,maximum diameter of dilated segments in postoperative specimens,histological inflammation of bowel walls,postoperative complications,length of hospital stay,and hospitalization costs.ResultsThere were no statistically significant differences among groups in age at first visit,birth weight,age at definitive surgery,gender,or surgical method(P>0.05).There were also no statistically significant differences in colostomy rates,weight at definitive surgery,duration of surgery,length of resected bowel,histological inflammation of bowel walls,postoperative complications,days in hospital,or hospitalization costs between Groups A and B(P>0.05).For Groups C and D,there were no statistically significant differences in weight at definitive surgery,duration of surgery,or length of resected bowel(P>0.05).In Group A,3 cases of small intestine-colonitis related to Hirschsprung diseas

关 键 词：先天性巨结肠 外科手术 儿童 

分 类 号：R47[医药卫生—护理学]