改良Duhamel术治疗成人先天性巨结肠及其类缘病

Modified Duhanmel procedure versus low anterior resection for Hirschsprung's disease and its allied disorder in adults

目的:探讨改良Duhamel术治疗成人先天性巨结肠(Hirschsprung’s disease,HD)及先天性巨结肠类缘病(Hirschsprung’s allied disorder,HAD)的疗效与安全性。方法:回顾性分析2012年1月至2011年1月间在重庆医科大学附属第一、第二医院Ⅰ期接受改良Duhamel术(D组,n=16)或低位直肠前切除术(L组,n=13)治疗的29例成人HD及HAD患者的临床资料。结果:无术中死亡病例。D组在术前生活质量评分[(2.2±0.7)分;(15.1±1.0)分]、手术时间(160±21)min和术后并发症发生率上与L组差异均无统计学意义(P>0.05)。但D组术中出血量(54.4±23.7)ml少于L组(t=2.394,P=0.028),术后住院时间(12.6±4.1)d短于L组(t=2.381,P=0.025),术后生活质量评分(4.4±1.4;17.9±1.2)分高于L组(t=2.090,P=0.046;t=2.224,P=0.035)。有严重并发症未解决或接受再次手术的6例病例视为手术失败,其中D组2例,L组4例。结论:改良Duhamel术治疗HD及HAD疗效确切,安全性高。

Objective：To evaluate the clinical efficacy and safety of modified Duhamel procedure for Hirschsprung＇s disease （HD） and Hirschsprung＇s allied disorder（HAD） in adults. Methods：Clinical data of 29 adult patients with HD and HAD who underwent one- stage modified Duhamel procedure（D group,n=16） or low anterior resection（L group,n=13） between January 2001 and January 2012 were analyzed respectively. Results：All operations were one-stage procedure without death case. There was no significant difference in mean preoperative life quality score（（2.2±0.7） or （15.1 ± 1.0））, operation time （（ 160± 21） rain） and incidences of postoperative complications between two groups （P〉0.05）. However, there were less mean intraoperative blood loss （（54.4 ± 23.7） ml,t=2.394, P= 0.028） ,shorter mean postoperative hospital stay（ （ 12.6 ± 4.1 ） d,t=2.381 ,P=0.025） and higher postoperative life quality score（ （4.4± 1.4） ,t=2.090,P=0.046 and （17.9 ± 1.2） ,t=2.224,P=0.035） in D group compared with those of L group. Of the six patients who were considered treatment failures with unsolved serious complications or reoperations, 2 patients were from D group and 4 patients were from L group. Conclusions ： Modified Duhamel procedure is safe and effective in the treatment of HD and HAD in adults.