腹腔镜辅助与单纯经肛门改良Soave术在新生儿普通型先天性巨结肠治疗中的应用比较

Comparison of the application of laparoscopic-assisted and modified transanal Soave pull-through procedure in the treatment of popular type Hirschsprung′s disease in neonates

目的对比腹腔镜辅助与单纯经肛门改良Soave术治疗新生儿普通型先天性巨结肠(HD)的临床效果。方法回顾性分析本院收治的65例普通型HD新生儿的临床资料,根据手术方式分为观察组(35例)与对照组(30例),对照组采用单纯经肛门改良Soave术,观察组在腹腔镜辅助下行经肛门改良Soave术。对比2组患儿的围术期情况、手术效果、并发症情况等。结果观察组患儿的手术时间、肠管切除长度均显著长于对照组,肛门解剖时间、术后住院时间均显著短于对照组,术中出血量显著少于对照组(P<0.05);观察组患儿术后6个月、12个月的肛门功能优良率分别为84.38%和100%,均显著高于对照组的77.78%和88.00%(P<0.05)。与术前相比,2组患儿术后6个月、12个月的肛门静息压均明显降低、直肠肛管角均明显增大,观察组术后6个月、12个月的肛门静息压均显著高于对照组,直肠肛管角显著低于对照组(P<0.05)。观察组患儿术后的并发症总发生率低于对照组(P<0.05)。结论腹腔镜辅助经肛门改良Soave术治疗新生儿普通型HD较单纯经肛门改良Soave术疗效更好,术后并发症更少,安全性更高。

Objective To compare the clinical effectiveness of laparoscopic-assisted and modified transanal Soave pull-through procedure in the treatment of popular type Hirschsprung′s disease(HD)in neonates.Methods A total of 65 popular type HD neonates who were admitted to the Affiliated Children′s Hospital of Soochow University were enrolled and their clinical data were retrospectively analyzed.According to different surgical methods,they were divided into two groups:an observation group(n=35)and a control group(n=30).The control group underwent modified transanal Soave pull-through procedure,while the observation group performed laparoscopic-assisted transanal Soave pull-through procedure.Both groups were compared for the perioperative conditions,surgical effects and complications.Results The observation group showed remarkable increases in surgical time and the length of resected bowel,decreases in the anal anatomy time and the length of postoperative hospitalization stay,and decreases in the intraoperative blood loss,compared with the control group(P<0.05).For the observation group,the excellent and good rate of anal function was 84.38%and 100%at postoperative 6 and 12 months,respectively,which were significantly higher than those in the control group(77.78%and 88.00%,both P<0.05).Compared with those before surgery,both groups presented significantly reduced resting anal pressure and increased anorectal angle at postoperative 6 and 12 months.The observation group showed remarkable increases in resting anal pressure and decrease in anorectal angle then the control group at postoperative 6 and 12 months(P<0.05).The total incidence of postoperative complications was lower in the observation group and the control group(P<0.05).Conclusions Compare with the dified anal Soave operation,laparoscopic-assisted modified anal Soave pull-through procedure is effective in the treatment of popular type HD,with little postoperative complications,with less complications and higher safety.