经肛门改良Soave术Ⅰ期根治先天性巨结肠的手术效果评估

Evaluation of Operation Effect of One-Stage Modified Soave Transanal Endorectal Pull-Through on Hirschsprung's Disease

目的评价经肛门改良Soave术Ⅰ期根治先天性巨结肠(HD)的手术效果。方法收集2001年1月-2008年11月经肛门改良Soave术Ⅰ期根治HD的患儿35例及经腹会阴Soave术治疗HD的15例患儿的临床资料,对其围术期疗效(手术时间、术中出血量、术后胃肠功能恢复时间、术后应用抗生素时间、住院天数)、术后并发症、排便功能、钡灌肠造影检查及直肠肛管测压(直肠肛管抑制反射、肛管静息压、直肠静息压)进行随访,随访0.5～6.0a。同时对此2种术式进行评估。采用SPSS13.0软件进行统计学分析。结果经肛门改良Soave术Ⅰ期根治HD的患儿手术时间短、术中出血少、术后胃肠功能恢复时间早、住院时间短,恢复快,术后并发症少,与开腹Soave术患儿比较差异均有统计学意义(Pa<0.05);经肛门改良Soave术Ⅰ期根治HD术后均未引出直肠肛管抑制反射,术后肛管静息压、直肠静息压与开腹Soave术比较差异均有统计学意义(Pa<0.05);但2种术式术后排便功能及钡灌肠造影结果比较差异均无统计学意义(Pa>0.05)。结论经肛门改良Soave术Ⅰ期根治HD可减少术后并发症,主要适用于普通型和短段型HD患儿,尤其适用于婴幼儿。

Objective To evaluate the surgical effect of one -stage modified Soave transanal endorecta] pull -through on Hirschs- prung＇s disease（HD）. Methods From Jan. 2001 to Nov. 2008,35 cases of HD underwent modified Soave procedure,and 15 cases received laparotomy Soave operation. The perioperative therapeutic effects（ operative time, bleeding,postoperative recovery of stomach intestine func- tion, day of using antibiotics and hospital day）, postoperative complications, bowel movements, barium enema and anorectal manometry （rec- toanal inhibitory reflex, resting rectal and anal canal pressure） were analyzed. They were followed up from 0.5 to 6.0 years after operation, and meanwhile 2 different operation types were evaluated at the sametime. SPSS 13.0 software was used to analyze the data. Results The mean operative time, bleeding,postoperative recovery of stomach intestine function, hospital day and postoperative complications in modified Soave procedure were all shorter than those by laparotomy Soave operation（ P 〈 0.05）. The rcetoanal inhibitory reflex was not elicited after operation. Moreover,there was difference in the resting rectal and anal canal pressure（p 〈0.05 ）. However,there was no difference in bowel movements and barium enema between 2 groups after operation（P 〉 0. 05）. Conclusions Modified Soave procedure may decrease the postoperative complications of HD, which may be applied to the cases of popular type HD and short - segment type HD, especially in infants.