腹腔镜辅助Soave手术治疗小儿结肠脾曲综合征的临床体会

Clinical experiences of laparoscopic-assisted Soave surgery in children with colon splenic flexure syndrome

目的：探讨腹腔镜辅助Soave手术治疗小儿结肠脾曲综合征的治疗效果与安全性。方法：回顾分析2005～2012年为52例结肠脾曲综合征患者行腹腔镜辅助Soave手术的临床资料。患儿均以反复便秘为主要临床表现，钡荆灌肠检查脾曲较肝曲升高〉1．5～2．0椎体，脾曲夹角〈45度，横结肠扩张，降结肠冗长。结果：52例手术均获成功，手术时间80～95min，平均（88±5．32）min：术中出血量2—5ml，平均（3±0．78）ml；切除肠管22—42cm，平均（36±2．26）cm；术后24h肠鸣音恢复，肛门排气或排便，术后恢复饮食时间1～2d。术后体温≤37．5℃。腹部切口甲级愈合率100％。术后肛周轻度污粪2例，无一例发生切口感染、结肠回缩、夹层感染、切口疝等并发症。术后随访8～85个月，平均（62±5．42）个月，效果满意；随小儿年龄的增长，大便次数逐渐减少，远期大便2～4次／d。结论：腹腔镜辅助Soave手术具有操作简单、创伤轻、出血少、并发症少、安全、切口美观等优点，是治疗小儿结肠脾曲综合征的理想术式。

Objective：To investigate the effectiveness and safety of laparoscopic-assisted Soave surgery in the treatment of pedi- atric splenic flexure syndrome. Methods： The clinical data of 52 children with splenic flexure syndrome who underwent laparoscopic-as- sisted Soave surgery from 2005 to 2012 were retrospectively analyzed. Repeated constipation was the main clinical manifestation in chil- dren. Barium enema examination showed the splenic flexure elevated 1.5 to 2.0 vertebras compared to the hepatic flexure, and the angle of colon splenic flexure was less than 45 degrees, while the transverse colon dilated with extended descending colon. Results ： All the 52 operations were successfully done. The operation time was 80-95 min, the mean was （ 88± 5.32） min ; the blood loss was 2-5 ml, the av- erage was （ 3±0.78 ） ml; the length of resected bowel was 22-42 cm, the average was （ 36 ± 2.26） cm. The restoration of bowel sounds, anus flatus or defecation occmxed within 24 h, while the food intake started from 1-2 d after surgery. Postoperative body temper- ature was ≤37.5℃ in all cases. Grade A incision healing rate was 100%. Mild postoperative perianal fecal pollution occurred in 2 ca- ses without incision infection, colon retraction, mezzanine infection, incisional hernia or other complications. Patients were followed up for 8 to 85 months,the average was （62 ± 5.42） months, and the results were satisfactory. As the growth of children, the stool frequency gradually reduced to 2-4 times/d. Conclusions：Laparoscopic Soave surgery is the preferred surgical technique for the treatment of pedi- atric splenic flexure syndrome with simpler operation,less trauma arid bleeding, fewer complications, more safety and aesthetic advantages.