腹腔镜下改良Soave术Ⅰ期治疗小儿长段型先天性巨结肠疗效观察

One-stage treatment of long segment Hirschsprung'disease in children using laparoscopic modified Soave procedure

目的研究腹腔镜下改良Soave术Ⅰ期治疗小儿长段型先天性巨结肠的效果。方法选择2009年1月—2016年1月入蚌埠医学院第一附属医院小儿外科诊断为先天性巨结肠长段型患儿共86例,根据随机数字表法分为对照组和观察组各43例。其中对照组男30例,女13例,年龄3~15个月,平均(6.7±3.3)个月,体重5~13kg,平均(7.8±2.6)kg;观察组男31例,女12例,年龄3.5~14.0个月,平均(6.3±3.5)个月,体重5.5~12.5kg,平均(8.6±2.8)kg。对照组采用开腹改良Soave术,观察组应用腹腔镜下改良Soave术,对比观察2组患儿的手术时间、术中出血量、切除肠管长度、术后肠蠕动恢复时间、禁食时间、术后住院时间、术后肛门功能及术后并发症。结果 2组手术均顺利进行,无死亡并发症。2组切除肠管长度差异无统计学意义(P>0.05),观察组的手术时间、术中出血量、术后住院时间、肠蠕动恢复时间和禁食时间明显较对照组低,差异有统计学意义(P<0.05)。随访12个月,观察组的肛门功能优良率高于对照组,差异有统计学意义(P<0.05)。观察组的早期和晚期并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。结论腹腔镜下改良Soave术Ⅰ期治疗小儿长段型先天性巨结肠与传统开腹手术相比,具有创伤小、恢复快、并发症少的优点,手术方式是安全、有效的。

Objective To study the effect of one-stage treatment of long segment Hirschsprung'disease Ⅰ children by using laparoscopic modified Soave procedure. Methods A total of 86 cases of long segment Hirschsprung'disease in our hospital between January,2009 and January,2016 were enrolled and divided randomly into control group and observation group of 43 cases with the random number table method. There were 30 boys and 13 girls in the control group,aging from 3 to 15 months,6. 7 ± 3. 3 on average,weighting from 5 to 13 kg,( 7. 8 ± 2. 6) kg on average; there were 31 boys and 12 girls in the observation group,aging from 3. 5 to 14 months,6. 3 ± 3. 5 on average,weighting from 5. 5 to 12. 5 kg,8. 6 ±2. 8 kg on average. The control group received common transanal modified Soave operation,while the observation group received laparoscopic modified Soave procedure. The operation time,peroperative bleeding,the length of bowel removed,recovery time of bowel peristalsis( sound),fasting duration,postoperative length of hospital stay,anal function,and complications were compared between the two groups. Results The operations in the two groups were successfully without death cases. The length of bowel removed in the two groups were no statistical difference,but the operation time,peroperative bleeding,length of hospital stay,bowel peristalsis recovery time and fasting duration in the observation group were less than those in the control group( P < 0. 05). The excellent rate of anal function after 12 months in the observation group was significantly better( P < 0. 05). The early and late complication rate in the observation group were both less( P <0. 05). Conclusion Compared with the traditional laparotomy,one-stage laparoscopic modified Soave procedure has the advantages of small trauma,rapid recovery,and fewer complications in treatment of long-segment Hirschsprung'disease in neonates,and the surgical mode is safe and effective.