改良Soave和改良Swenson术治疗儿童短段型巨结肠的对比研究

Modified Soave versus modified Swenson in treatment of children with short segment megacolon

目的对比分析改良Soave与改良Swenson术治疗儿童短段型先天性巨结肠(hieschsprung disease,HD)的临床疗效。方法回顾性分析2016年1月至2019年12月本院收治的短段型HD患儿63例临床资料,并以手术方式为依据分为A组(28例)与B组(35例)。A组行改良Soave术治疗,B组行改良Swenson术治疗,对此分析两组患儿一般资料、术中、术后临床指标以及术后排便功能情况及并发症发生情况。结果B组手术时间、出血量分别为(137.22±25.63)min、(11.32±6.84)ml,均低于A组(182.64±47.82)min、(26.56±12.43)ml,差异均有统计学意义(均P<0.05);两组患儿切除肠管长度比较,差异无统计学意义(P>0.05);两组患儿尿管留置时间、进食时间比较,差异均无统计学意义(均P>0.05);B组平均住院时间为(10.24±2.96)d,明显短于A组(13.53±3.62)d,差异有统计学意义(P<0.05);两组患儿排便频率、便秘、污粪比较,差异均无统计学意义(均P>0.05);B组自主大便率为88.57%,明显高于A组67.86%,差异有统计学意义(P<0.05);B组并发症发生率为8.57%,明显低于A组28.57%,差异有统计学意义(P<0.05)。结论治疗儿童短段型HD而言,改良Swenson术总体临床疗效优于改良Soave术,具体表现为术中出血量更少、手术时间及住院时间更短,且并发症发生率更低。

Objective To compare and analyze the clinical treatment effects of modified Soave and modified Swenson surgery for children with short segment megacolon.Methods The clinical data of 63 children with short-segment megacolon who were admitted to our hospital from January,2016 to December,2019 were retrospectively analyzed.They were divided into group A(n=28)and B Group(n=35)according to the surgical methods.Group A received modified Soave surgery,and group B modified Swenson surgery.The general information,intraoperative and postoperative clinical indicators,postoperative defecation function,and complications of the two groups were analyzed.Results There were no statistical differences between the two groups in gender,age,weight,preoperative fever,preoperative abdominal distention,and other general information(all P>0.05).The operation time was shorter and the bleeding volume was lower in group B than in group A[(137.22±25.63)min vs.(182.64±47.82)min and(11.32±6.84)ml vs.(26.56±12.43)ml;both P<0.05].There were no statistical differences between the two groups in the length of intestinal resection,urinary catheter indwelling time,and feeding time(all P>0.05).The hospitalization time was significantly shorter in group B than in group A[(10.24±2.96)d vs.(13.53±3.62)d;P<0.05].There were no statistical differences in defecation frequency and incidences of constipation and defiled feces between these two groups(all P>0.05).The rate of spontaneous defecation in group B was significantly higher than that in group A(88.57%vs.67.86%;P<0.05).The incidence of complications in group B was significantly lower than that in group A(8.57%vs.28.57%;P<0.05).Conclusion The overall clinical efficacy of modified Swenson is superior to modified Soave in the treatment of children with short-segment megacolon,which is manifested by less intraoperative blood loss,shorter operation time and hospital stay,and lower incidence of complications.