经肛soave术对新生儿期巨结肠相关性小肠结肠炎的影响研究

Study on the effect of trans-anal soave surgery on hirschsprung-associated enterocolitis during neonatal period

目的:探讨新生儿期经肛门SoaveⅠ期拖出根治术(经肛soave术)对巨结肠相关性小肠结肠炎(HAEC)的治疗效果和术后影响。方法:回顾性分析新生儿期先天性巨结肠普通型及以下类型的病例中研究组76例行经肛soave术和对照组49例行传统结肠造瘘术,统计两组对HAEC的治疗效果和术后发病情况,并分析研究组扩张肠段的额外切除对HAEC的影响。结果:对于术前合并HAEC,经肛soave组死亡5例,治愈率91.07%,对照组死亡3例,治愈率92.11%,两组差异无统计学意义(P>0.05)。经肛soave术组术后有23例并发HAEC,发病率30.27%,对照组并发HAEC17例,发病率34.69%,两组差异无统计学意义(P>0.05)。同时,扩张段的额外切除(n>5cm)对HAEC治愈率和术后发病率也无明显影响。结论:与传统结肠造瘘术相比,经肛Soave术对HAEC能够达到相同的治愈效果,术后HAEC的发病率也无明显差异;新生儿期经肛saove术中扩张段的额外切除并不能提高小肠结肠炎的治愈率和降低术后发生率。

Objective：To explore the curative effect of trans-anal soave surgery in treatment of hirschsprung-associated enterocolitis（HAEC） during neonatal period and the influence after surgery.Methods：The neonates with common type and the following types of neonatal congenital megacolon were analyzed retrospectively,76 neonates in study group were treated with trans-anal soave surgery and 49 neonates in control group were treated with traditional colostomy.The curative effects for HAEC and postoperative incidences of HAEC in the two groups were analyzed statistically,the effect of additional resection of dilated intestinal canal on HAEC in study group was analyzed.Results：Among the neonates with HAEC before surgery,five neonates died in study group,the curative rate was 91.07%;three neonates died in control group,the curative rate was 92.11%,there was no significant difference between the two groups（P0.05）.After surgery,23 neonates in study group were found with HAEC,the incidence was 30.27%;17 neonates in control group were found with HAEC,the incidence was 34.69%,there was no significant difference between the two groups（P0.05）.Meanwhile,additional resection of dilated intestinal canal（5 cm） had no obvious impact on the curative rate of HAEC and the postoperative incidence of HAEC.Conclusion：Compared with traditional colostomy,trans-anal soave surgery can get the same curative effect for the neonates with HAEC,there is no significant difference in the incidence of postoperative HAEC between the two methods;additional resection of dilated intestinal canal during trans-anal soave surgery can＇t increase the curative rate of enterocolitis and reduce the postoperative incidence of HAEC during neonatal period.