经脐单部位腹腔镜与传统开腹手术治疗巨结肠及同源病的临床疗效比较

A comparison of transumbilical single-site laparoscopic surgery with open surgery subtotal colectomy for hirschsprung’s disease and its allied disorder in children

目的：比较经脐单部位腹腔镜（embryonic natural orifice transumbilical endoscopic sur-gery，ENOTES）与传统开腹手术行结肠次全切除术治疗长段型先天性巨结肠及巨结肠同源病的临床疗效。方法先天性巨结肠及巨结肠同源病患儿61例，其中长段型先天性巨结肠33例，巨结肠同源病28例。将上述61例患儿分为两组：经脐腹腔镜组及开腹手术组，比较两组患儿的手术时间、术中出血量、肠蠕动恢复时间及手术近、远期并发症，并作统计学分析。结果经脐单部位腹腔镜组较开腹组手术时间长[（24.60±44.50）min 比（182.80±47.24）min，P ﹤0.05]，经脐单部位腹腔镜组术后肠蠕动恢复更快[（21.32±2.55）h 比（36.54±6.60）h，P ﹤0.05]，两组术中出血量比较差异无统计学意义[（78.60±40.25）ml 比（96.76±8.79）ml，P ﹥0.05]，开腹组的术后近、远期并发症发生率均高于经脐腹腔镜组（P ﹤0.05）。结论经脐单部位腹腔镜较开腹次全结肠切除对患儿手术创伤小，术后肠蠕动恢复快，腹部伤口外形美观，术后并发症低。

Objective To compared the therapeutic effect of transumbilical single-site laparo-scopic sugery subtotal colectomy with open surgery subtotal colectomy in children with long-sengment Hir-schsprung disease（LSHD）and Hirschsprung disease allied disorder（HAD）. Methods A total of 61 chil-dren with LSHD and HAD were included in our retrospective study,33 cases were LSHD,while 28 cases were HAD. The patients were divided into 2 groups：transumbilical single-site laparoscopic group and open surgery group. The operative time,operative bleeding,bowel peristalsis recovery time,and postoperative complications in short time and in long time after operation were analyzed. Results Compared to open surgery,transumbilical single-site laparoscopic had longer operative time[（24. 60 ± 44. 50）min vs （182. 80 ± 47. 24）min,P ﹤ 0. 05],but shorter bowel peristalsis recovery time[（21. 32 ± 2. 55）h vs （36. 54 ± 6. 60）h,P ﹤ 0. 05],there was no significant difference in operative bleeding[（78. 60 ± 40. 25） ml vs（96. 76 ± 8. 79）ml,P ﹥ 0. 05]. In addition,there were less complications in short and long time fol-low up in ENOTES than open surgery（P ﹤ 0. 05）. Conclusion transumbilical single-site laparoscopic subtotal colectomy can gain less surgical trauma,quicker bowel peristalsis recovery,better cosmetic out-comes,less complications than open surgery.