先天性巨结肠经肛门Soave Ⅰ期拖出术后功能随访

A follow-up study on the bowel function after transanal Soave one-stage endorectal pull-through procedure for Hirschsprung＇ s disease

目的评估先天性巨结肠经肛门Soave Ⅰ期拖出术后排便功能。方法随访2000年10月-2004年10月经肛门Ⅰ期拖出术44例，开腹Soave术35例，腹腔镜Soave术29例，Ikeda-soper术39例。术后随访1～5年。对围手术期疗效（术前准备时间、手术时间、术中输血量、术后禁食天数、应用抗生素时间、住院天数及费用）及术后排便控制能力（Kelly评分和直肠肛管测压）进行评估。结果经肛门Ⅰ期拖出术平均手术时间（75±20）min、费用（8198．81元）低于开腹术[（92±25）min；10264．45元]、腹腔镜术[（125±25）min；12504．67元]（P〈0．05）；术前肠道准备（2d）、手术时间（75±20）min、术中输血量（0例）、术后禁食天数（2d）、应用抗生素时间（4±1）d、住院天数（11±2）d及费用（8198．81）元较Ikeda-soper术[（4±1）d；（240±30）min；32例；（5±1）d；（7±2）d；（19±3）d；15243．78元]显著降低（P〈0．01）。经肛门Ⅰ期拖出术后的近远期并发症发生情况与开腹术、腹腔镜术无显著差别（P〉0．05）；Soave术后3个月小肠结肠炎的发生率（12例）高于Ikeda-soper术（3例）（P〈0．05），但就经肛门Soave术（5例）与Ikeda-soper术（3例）比较，差异无显著性意义（P〉0．05）。经肛门Ⅰ期拖出术和Ikeda-soper术患儿术后12个月Kelly评分无差别；术后1年直肠肛管测压均未引出直肠肛管抑制反射，术后肛管高压区长度、肛管静息压、直肠感觉阈值无统计学差异，但经肛门SoaveⅠ期拖出术后主动收缩压（52．3±15．6）mmHg低于Ikeda-soper术后（55．7±15．4）ramHg。结论经肛门SoaveⅠ期拖出术创伤小、并发症少、费用明显低于开腹、腹腔镜Soave术以及Ikeda-soper术，适用于治疗小年龄婴幼儿的短段型和常见型先天性巨结肠。

Objective To evaluate the bowel movement in children with Hirschsprung＇s disease （HD） after transanal Soave one-stage endorectal pull-through（TAS） procedure. Methods From October 2000 to October 2004, 44 patients with HD underwent TAS procedure, 35 received laparotomy Soave operation, 29 underwent laparoscopy Soave procedure and 39 received Ikeda-soper operation were followed up from 1 to 5 years after operation. The evaluation of perioperative therapeutic effects and postoperative bowel movements between these four groups was analyzed by Kelly＇s score and anorectal manometry. Results The mean operative time in the TAS procedure was shorter than that in laparotomy and laparoscopy Soave procedure （P〈0.05）, and the expense in the TAS was lower than that in laparotomy and laparoscopy Soave procedure （P〈0. 05）. Moreover, the operation, postoperative fasting, antibiotics use, hospitalization time in TAS group were much shorter than those in the Ikeda-soper （P〈0. 01 ）, and the expense in the TAS was also lower than that in the Ikeda-soper. There was no difference in short and long term complications between the TAS and laparotomy or laparoscopy Soave procedures. There was no difference of the incidence of enterocolitis between TAS procedure and Ikeda-soper operation. There was no difference in bowel movement among these groups at 12 months after operation. Moreover, there were no significant difference of rectal anal inhibitory reflex, high pressure zone length, resting anal canal pressure and sensation threshold between TAS procedure and Ikeda-soper operation at 1 year after operation. However, TAS procedure had the lower active contractive pressure than that in Ikeda-soper operation. Conclusions The satisfactory short and long-term results can be achieved in TAS procedure for children with HD, especially in young patients with short-segment type and common type of HD.