腹腔镜下经肛门改良Soave术Ⅰ期治疗小儿先天性巨结肠效果观察

Observation on the effect of laparoscopic transanal modified Soave operation in the treatment of congenital megacolon in children

目的 探讨腹腔镜下经肛门改良直肠黏膜剥除鞘内结肠拖出术(Soave)Ⅰ期治疗小儿先天性巨结肠(HD)的效果。方法 选择2019年1月—2020年12月利川市人民医院收治的HD患儿84例,随机分为2组各42例。对照组行开腹改良Soave术,观察组行腹腔镜下经肛门改良Soave术,比较2组临床指标、肛门功能[肛管高压区长度、肛管静息压(ARP)]、肠道菌群及并发症。结果 观察组手术时间、肠蠕动恢复时间、住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05)。观察组术后大肠杆菌低于对照组,粪肠杆菌、乳酸杆菌、肛管高压区长度、ARP高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论在HD患儿中采用腹腔镜下改良Soave术Ⅰ期治疗效果较好,可缩短手术时间,减少术中出血量与术后并发症,改善肛门功能及肠道菌群。

Objective To investigate the effect of laparoscopic transanal modified rectal mucosal exfoliation and intrathecal colon pull-out(Soave) in the treatment of children with congenital megacolon(HD). Methods 84 children with HD treated in our hospital from January 2019 to December 2020 were randomly divided into two groups,42 cases in each group.The control group underwent open modified Soave operation,and the observation group underwent laparoscopic transanal modified Soave operation. The clinical indexes,anal function [length of anal high pressure area,anal resting pressure(ARP)],intestinal flora and complications were compared between the two groups.Results The operation time,recovery time of intestinal peristalsis and hospital stay in the observation group were shorter than those in the control group,and the amount of intraoperative bleeding was less than that in the control group(P<0.05).The postoperative Escherichia coli in the observation group was lower than that in the control group,and the length of fecal enterobacter,Lactobacillus,anal high pressure area and ARP in the observation group were higher than those in the control group(P<0.05);The incidence of complications in the observation group was lower than that in the control group(P<0.05).Conclusion The effect of laparoscopic modified Soave I in HD children is better,which can shorten the operation time,reduce the amount of intraoperative bleeding and postoperative complications,and improve the anal function and intestinal flora of children.