两种先天性巨结肠根治术疗效的对比研究

Comparison between two operative methods for Hirschsprung′s disease

目的：探讨改良Swenson术和经肛Soave术在先天性巨结肠（Hirschsprung’sdisease，HD）的疗效方面的优劣性。方法：回顾分析1999年10月-2010年2月我院107例HD根治术的临床资料，根据手术方式的不同分为A组（改良Swenson术，共62例）和B组（经肛Soave术，共45例），统计分析两组的出血量、手术时间、术后禁食时间、术后住院时间及术后肠粘连、小肠结肠炎、切口感染、吻合口瘘、污粪、复发等并发症的发生率。结果：A组的出血量（t=2．63，P〈0．05）、手术时间（t=2．08，P〈0．05）、术后禁食时间（t=2．89，P〈0．05）、术后住院时间（t=1．94，P〈0．05）及术后肠粘连（χ2=-9．33，P〈0．05）、切口感染（χ2=-9．19，P〈0．05）、吻合口瘘（χ2=4．37，P〈0．05）、污粪（χ2=-7．72，P〈0．05）发生率均明显大于B组，其余差异无统计学意义。结论：经肛Soave术在疗效上优于改良Swenson术，但适应证小。术后污粪可能与肛管直肠角的改变有关。

Objective： To study the superior or inferior degrees between improved Swenson and transanal Soave for Hirsehsprung＇s disease （HD）. Methods： The data of 107 children with Hirsehsprung＇s disease undergoing operation from Oetober 1999 to February 2010 in our hospital were analyzed. The patients were divided into two groups according to the operative methods, group A （62 cases） with improved Swenson and group B （45 cases） with transanal Soave. The patients amount of bleeding, operation time, postoperative fasting time, postoperative stay, and the incident rate of the complication involved intestinaladhesion, enterocolitis, wound infeetions, anastomotie leakage, faecal pollution and recurrence were ana- lyzed. Results： The amount of bleeding （t=2.63, P〈0.05）, operation time （t=2.08, P〈0.05）, postoperative fasting time （t= 2.89, P〈0.05）, postoperative stay （t=1.94, P〈0.05）, and the incident rate of the complieation involved intestinaladhesion （χ2=9.33, P〈0.05）, wound infeetions （χ2=9.19, P〈0.05）, anastomotie leakage （χ2=4.37, P〈0.05）, faecal pollution （χ2=7.72, P〈0.05） of group A were more than those of group B, there was no significant differenee in other index. Conclusion： The effect of transanal Soave was better than improved Swenson, with the less indication. Furthermore, the postoperative faecal pollution has to do with the change of anoreetal angle.