经肛门改良Soave术Ⅰ期根治小儿先天性巨结肠的近期疗效及影响因素分析

Short-term efficacy and influencing factor analysis of modified transanal Soave surgery on hirschsprung′s disease infants in initial radial resection

目的：观察经肛门改良Soave 术Ⅰ期根治小儿先天性巨结肠（HD）的近期疗效，并分析其影响因素。方法：132例HD患儿于全身麻醉或骶管阻滞麻醉下施行经肛门改良SoaveⅠ期根治术，术后常规给予抗生素治疗。结果：共切除肠管标本19～56 cm，平均（35．07±3．15） cm；平均手术时间（120．48±18．34） min；术中平均出血（45．74±8．14） mL，所有患儿均于术后24 h 内恢复肠道功能，术后6个月肛门功能总优良率为90．90％。 Cox 模型多因素分析表明，吻合口狭窄、肠炎等并发症是术后6个月肛门功能优良与否的独立影响因素（P ＜0．05）。结论：经肛门改良Soave术Ⅰ期根治小儿HD创伤小，并发症少，术后肠炎及吻合口狭窄是近期疗效的独立影响因素。

Objective To observe the short-term clinical efficacy of modified transanal Soave surgery on infants with hirschsprung′s disease （HD） in initial radial resection, and to analyze the influencing factors. Methods 132 HD infants were selected. After initial radial resection with modified transanal , Soave surgery was conducted under general or sacral anesthesia. Postoperative antibiotics were routinely given. Results 19-56 cm intestinal canal samples were excised, with average length of （35.07 ± 3.15） cm. The average surgical duration and intra-operative hemorrhagic volume were （120.48 ± 18.34） min and verage was （45.74 ± 8.14） mL. All infants′ gastrointestinal function was recovered in 24 h postoperatively. The total excellent and effective rate of anal function in 6 months was 90.90% postoperatively. Cox modal multivariate analysis suggested that anastomotic orifice stenosis and enteritis were the two factors that greatly influenced the excellent and effective rate of anal function 6 months after the surgery （P 〈 0.05）. Conclusion The modified transanal Soave surgery has small trauma and low complication rate on HD infants in initial radial resection , and the postoperative enteritis and anastomotic orifice stenosis are independent influencing factors for the short-term efficacy.