快速康复外科技术在1-4月龄婴儿巨结肠根治术中的应用

The experience of use fast track surgery in radical hirschsprung’s disease in infants

目的探讨快速康复外科技术（FTS）应用于小婴儿巨结肠中的可行性、安全性及临床与社会价值。方法收集本院2010年10月至2013年10月应用快速康复外科技术治疗的1-4月龄婴儿巨结肠53例，为 FTS 组；选取2008年10月至2010年10月采取传统方式治疗，与 FTS 组条件相同，总体临床特点相似的1-4月龄婴儿巨结肠40例，作为对照组。全部病例均进行一期巨结肠根治术，并获随访，随访时间6个月至5．5年；对两组病例术后首次排便时间、停止输液时间、住院时间、治疗费用和中期并发症等方面进行比较。结果FTS 组与传统组术后停止输液时间分别是（2．4±1．1）d、（3．5±1．2）d；住院时间分别是（7．4±1．2）d、（10．5±1．6）d；治疗费用分别是（8300±840）元、（11100±920）元，差异均有统计学意义（P ＜0．05）。两组术后首次排便时间分别是（10．3±1．8）h 和（11．5±2.4）h，第3天 CRP 正常比例分别是73．6％和55％，差异无统计学意义（P ＞0．05）；两组术后中期效果指标（便秘、污粪／肛门失禁、肛周感染，小肠结肠炎）比较，无显著差异（P ＞0．05）。结论快速康复外科技术应用于1-4月龄婴儿巨结肠可明显加速患儿康复，缩短住院时间，节省住院费用，安全有效，但需要逐步推进和多部门密切配合。

Objetive To investigate the feasibility,the safety,clinical and social value of fast track sur-gery （FTS）in infants with hirschsprung ＇s disease.Methods From Oct 2010 to Oct 2013 Of a total of 53 in-fants （1 -4 months）were finally treated according to the fast-track protocols.The control group of 40 cases which had the same conditions,the overall clinical features similar to the FTS groups were taken traditional pro-grams from Oct 2008 to Oct 2010.All cases were executed I period of megacolon radical operation.Follow up of 6 months -5.5 years.The two groups Were compared the first defecation time,intravenous fluids stopping time,the hospitalization time,total cost of treatment and the incidence of medium-term complications.Results The FTS group compared with the control group：：the intravenous fluids stopping time were 2.4 ±1.1 and 3.5 ±1.2 days respectively;the hospitalization time were 7.4 ±1.2 days and 10.5 ±1.6 days respectively;the total cost of treatment were 8 300 ±840 and 11 100 ±920 RMB respectively;the difference were statistically significant（P 〈0.05）.The first defecation time were 10.3 ±1.8 hours and 11.5 ±2.4 hours respectively;the normal CRP ratio were 73.6% and 55% respectively;both no significant difference（P 〉0.05）;Midterm effect index after operation in the two groups （constipation,fecal sewage /incontinence,anal infection,enterocoli-tis）had no significant difference （P 〉0.05）. Conclusion The feasibility and safty of fast-track surgery in Infants with hirschsprung ＇s disease is excellent,with short duration of hospitalization and high comfort which need to promote the gradual and multi departments work closely with.