腹腔镜辅助与常规开腹Soave’s术治疗患儿先天性长段型巨结肠的疗效对比

目的对比腹腔镜辅助Soave’s术和常规开腹Soave’s术治疗小婴儿先天性长段型巨结肠的临床疗效,旨在为此类患者选择治疗方案提供依据。方法回顾性分析2012年1月至2021年4月在徐州市儿童医院中心进行Soave’s术的先天性长段型巨结肠患儿102例,其中男性83例,女性19例;年龄11天~10个月,平均年龄3.08个月;体质量5.34~7.98 kg,平均体质量6.63 kg;出生体质量2.89~3.76 kg,平均出生体质量3.15 kg;5例患儿有家族史。根据手术方式分为观察组和对照组;观察组56例,行腹腔镜辅助Soave’s术;对照组46例,行常规开腹Soave’s术。记录所有患儿围手术期指标(手术时间、胃肠功能恢复时间、术中出血量、总住院时间等,以及术后留置导尿管时间)、术后肛门功能(包括Kelly评分、肛门静息压和肛管高压区长度的测量)、术后随访1年并记录并发症,对以上所有数据进行统计分析。结果与对照组对比,观察组手术时间显著缩短,出血量明显减少,总住院时间缩短,差异均有统计学意义(P<0.05);两组术后胃肠功能恢复速度、留置导尿时间比较,差异无统计学意义(P>0.05)。术后3个月所有患儿Kelly评分有所升高,且肛管高压区长度和肛门静息压力相比术前均有所提高,差异有统计学意义(P<0.05)。同时,治疗后观察组Kelly评分为(5.83±0.42)分,明显高于对照组(5.03分±0.63分);肛管高压区长度和肛门静息压分别为(2.26±0.29)cm、(53.63±7.53)mmHg,与对照组(2.13 cm±0.24 cm、50.72 mmHg±7.01 mmHg)相比,差异有统计学意义(P<0.05)。观察组并发症发生率小于对照组(23.21%vs 69.57%),差异有统计学意义(P<0.05)。结论在小婴儿长段型先天性巨结肠治疗中,腹腔镜辅助Soave’s术与常规开腹Soave’s术相比,在促进患儿术后恢复、肛门功能改善及减少术后并发症发生率等方面更具优势。

Introduction of PIC/S Accession Procedure and Suggestions for Establishing a Unified Quality Management System in China

Objective To introduce the accession procedure and evaluation of PIC/S,and help relevant departments in China to understand the requirements of PIC/S in detail,and to promote the process of China’s entry into PIC/S.Methods The procedures and steps of joining PIC/S,the evaluation process of PIC/S,and the experience of several countries in joining PIC/S were introduced and analyzed,which could help the relevant personnel in China understand the specific contents.Results and Conclusion According to the requirements of PIC/S,it is necessary to establish a unified GMP quality management system.

经肛门改良Swenson和Soave术治疗先天性巨结肠比较

目的比较经肛门改良Swenson术和Soave术治疗先天性巨结肠的疗效及优缺点。方法回顾性分析经肛门手术治疗的50例先天性巨结肠患儿临床资料，其中短段型11例，普通型35例，长段型4例；行经肛门改良Swenson术21例，经肛门改良Soave术29例。比较两组患儿手术相关因素、术后并发症及排便功能情况。结果两种术式术前灌肠时间、术中出血量、术后住院天数及出院时排便情况比较，无统计学意义（P〉0．05），而手术时间比较，前者较后者短（P〈0．05）。两组术后并发症的发生率分别为19．0％和37．9％，术后6个月时排便优良率为95．2％和89．6％。结论经肛门改良Swenson术和改良Soave术创伤小，恢复快，疗效好，但经肛门Swenson术较经肛门Soave术操作更简单方便，并发症明显减少；两者手术适应证均可适当放宽。

腹腔镜辅助Soave巨结肠根治术的中长期随访报告

目的总结腹腔镜辅助Soave巨结肠根治术115例的中长期随访疗效，评价术后肛门功能及生活质量，探讨腹腔镜辅助Soave巨结肠根治术的经验与效果。方法回顾性分析本院2008—2013年收治的115例先天性巨结肠患儿临床资料，术前均予钡剂灌肠、直肠肛门测压和直肠黏膜活检确诊，术中应用4个Tmcar，经腹腔探查找到移行和扩张的肠段；予多处浆肌层活检确定诊断和病变肠段范围，彻底游离病变肠管，经肛门直肠肌鞘内拖出切除，近端与肛门吻合。采取问卷调查方式评估患儿肛门功能、生长发育及生活质量评分。结果115例获随访1．5—7年，平均（51．32±21．05）个月，其中1—3年41例，3～5年42例，〉5年32例，参照Heikkinen评分标准：术后3个月、1年、3年肛门排便优良率分别为69．1％（76／115）、91．3％（105／115）、92．4％（91／98）；术后3个月、1年、3年肛门静息压力分别为（35．35±6.52）mmHg、（55．65±8．69）mmHg、（57．31±9．43）mmHg；与同年龄组肠套叠术后门诊复诊患儿肛门静息压力（60．11±8．69）mmHg比较，术后3个月肛门静息压力明显降低（t=12．926，P=0．000），术后第1年、第3年肛门静息压力与对照组比较无明显差异（t=1．851，P=0．07；t=1．117，P=0．270）；术后1年钡剂结肠造影显示结肠痉挛、移行及扩张段消失，肛管直肠角正常，患儿均生长发育正常。结论腹腔镜辅助Soave巨结肠根治术治疗先天性巨结肠创伤小，操作简单，安全有效，术后肠功能恢复快，中长期随访肛门功能和生活质量良好。

经肛门Soave根治术与开腹根治术治疗先天性巨结肠疗效比较

目的:对比经肛门Soave根治术与开腹巨结肠根治术对小儿先天性巨结肠的疗效。方法:回顾分析1991年1月—2011年12月252例先天性巨结肠患儿病历资料,其中开腹手术组121例,经肛门手术组131例。对比分析两组的手术时间、住院天数、术中出血、术后并发症、切口长度、肛门功能情况以及生活质量等。结果:与开腹手术相比,经肛门手术组手术时间短,术中出血量少,术后下床活动时间和进食时间短,术后切口感染、小肠结肠炎、腹腔感染等并发症发生率低,差异均有统计学意义(P<0.05)。2年随访,经肛门手术组的术后远期并发症如肠梗阻、排尿功能异常、术后复发等比开腹组少,远期恢复情况及生活质量比开腹组好,差异有统计学意义(P<0.05)。结论:与开腹手术相比较,经肛门Soave巨结肠根治术治疗小儿先天性巨结肠手术时间短、切口美观、住院时间短、术后并发症少、肛门功能恢复好、生活质量好。

经肛门改良Soave术Ⅰ期根治小儿先天性巨结肠的近期疗效及影响因素分析

目的：观察经肛门改良Soave 术Ⅰ期根治小儿先天性巨结肠（HD）的近期疗效，并分析其影响因素。方法：132例HD患儿于全身麻醉或骶管阻滞麻醉下施行经肛门改良SoaveⅠ期根治术，术后常规给予抗生素治疗。结果：共切除肠管标本19～56 cm，平均（35．07±3．15） cm；平均手术时间（120．48±18．34） min；术中平均出血（45．74±8．14） mL，所有患儿均于术后24 h 内恢复肠道功能，术后6个月肛门功能总优良率为90．90％。 Cox 模型多因素分析表明，吻合口狭窄、肠炎等并发症是术后6个月肛门功能优良与否的独立影响因素（P ＜0．05）。结论：经肛门改良Soave术Ⅰ期根治小儿HD创伤小，并发症少，术后肠炎及吻合口狭窄是近期疗效的独立影响因素。

Soave术根治全结肠型巨结肠中远期预后的相关因素分析

目的探讨Soave术根治全结肠型巨结肠的预后相关因素。方法回顾性分析2008年7月至2013年7月作者收治的31例全结肠型巨结肠Soave根治术患儿临床资料，并进行电话随访，随访时间2～6年，平均随访时间（3±2．4）年。电话随访内容包括患儿体重、排便次数、排便性状及大便失禁情况、术后小肠结肠炎的发生次数等。结果31例均行经腹会阴Soave术，其中3例行Ⅰ期根治术，28例行回肠造瘘术后再择期行根治术，患儿完成Soave术手术月龄1～13个月，平均（5．2±2．3）个月，手术时平均体重（6．4±2．5）kg，手术剩余小肠长度90～250cm，平均（169±40）cm，近端肠管中见发育成熟的神经节细胞24例，发育较成熟的神经节细胞7例。患儿按年龄别体质量：术后正常者19例，轻度营养不良8例，中度营养不良3例。术后患儿均无大便失禁，3例偶有污粪，无肛门狭窄需扩肛病例。粪便呈糊状或成形28例（28／31例），糊状或水样3例（3／31例）；每日排便次数〈5次28例，6次或以上3例；术后小肠结肠炎〈2次24例，3次或以上7例。手术剩余小肠越长，大便情况越好；近端肠管发育成熟神经节细胞患儿术后小肠结肠炎的发生率较发育较成熟患儿明显降低（P〈0．01）。结论全结肠型巨结肠患儿实施经腹会阴Soave术远期疗效满意，能获得较好的营养发育和直肠肛门功能，手术后剩余小肠长度和近端肠管神经节细胞发育成熟度是影响远期预后的重要因素。

腹腔镜辅助改良Soave’s法I期根治小儿先天性巨结肠症的效果观察

目的探讨腹腔镜辅助改良Soave’s法I期根治小儿先天性巨结肠症的手术方式，并评价临床疗效。方法回顾性分析2010年9月至2011年9月行腹腔镜辅助改良Soave’s法I期根治小儿先天性巨结肠11例患儿的临床资料。结果11例患儿中男8例，女3例；年龄4个月至11岁。常见型6例，短段型4例，长段型1例。11例患儿手术时问80～130min，平均（120±10）rain，术中平均出血量为（20±5）ml，肠蠕动恢复平均时间为（24±4）h，愈合后瘢痕不明显，无并发症发生。结论腹腔镜辅助下行小儿先天性巨结肠根治术可行，具有直观、创伤小，在分离盆底直肠方面优于开放手术，具有恢复快、疗效好等优点。

经肛门改良Soave根治巨结肠的临床研究

目的:探讨经肛门改良Soave巨结肠根治术的手术方法及手术效果的临床研究。方法:实验组:23例已证实的先天性短段型及普通型巨结肠患儿行改良Soave巨结肠根治术。对照组:16例行De La Torre术式巨结肠根治术。结果:所有患儿无术中及术后死亡,对照组中6例近期出现小肠结肠炎,大便失禁1例,污粪1例,吻合口狭窄3例。实验组仅1例出现污粪,经扩肛后治愈。结论:经肛门改良Soave巨结肠根治术是一种安全高效、微创、并发症少的术式,值得临床推广应用。

腹腔镜辅助经肛门改良Soave术根治小儿先天性巨结肠63例临床总结

目的总结腹腔镜辅助经肛门改良Soave术根治小儿先天性巨结肠的临床疗效。方法回顾性分析我院2004年1月至2012年11月收治先天性巨结肠患儿121例，其中63例采用腹腔镜辅助经月T门改良Soave术，58例采用单纯性经月T门改良Soave术，分析两组患儿手术过程及术后并发症以及排便情况。结果腹腔镜组的手术时问为（2±0．8）h，小于对照组（t=2．586，P〈O．05），术中j十I血量为（20±3．5）ml，少于对照组（t=1．834，P〈O．05）。两组均在术后1天有肛门排气，腹腔镜辅助经肛门改良Soave术后出现小肠结肠炎与单纯经肛门改良Soave术无显著差异；无l例ff}现肛门回缩，肠扭转；术后出现月下门狭窄与对照组比较差异无统计学意义；术后并发症更少，排便情况差异无统计学意义。结论腹腔镜辅助经肛门改良Soave术是一种适用范围更加广泛、全面、安全、有效的手术方法。

经肛门Soave改良术和开腹根治术治疗先天性巨结肠疗效分析

目的观察经肛门Soave改良术和开腹根治术治疗小儿先天性巨结肠的疗效。方法 160例先天性巨结肠患儿中,80例接受经肛门Soave改良术(治疗组),80例患者接受传统开腹根治手术(对照组)。分别对两组的手术时间、出血量、术后肠蠕动恢复时间、术后住院时间以及近期并发症进行分析,对患儿的肛门功能以及生活质量进行随访和问卷调查并评分。结果治疗组手术时间、手术出血量、住院时间以及肠功能恢复时间均低于对照组(P<0.05);治疗组术后并发症总发生率显著低于对照组(P<0.05)。160例患儿经随访6个月～5年,治疗组患儿的肛门功能优良率以及生活质量优良率均明显高于对照组,差异有统计学意义(P<0.05)。结论经肛门Soave改良术治疗小儿先天性巨结肠安全有效,且患儿排便控制功能和生活质量明显提高,值得临床推广使用。

腹腔镜下行改良Soave术治疗新生儿先天性巨结肠的疗效观察

目的观察腹腔镜下行改良Soave术治疗新生儿先天性巨结肠的疗效。方法选取我院收治的先天性巨结肠新生儿50例,将其随机分为观察组和对照组各25例。观察组给予腹腔镜下改良Soave术治疗,对照组给予传统Soave术治疗,比较两组的治疗效果。结果观察组的手术时间、术中出血量、抗生素使用时间、胃肠功能恢复时间、住院天数等均显著少于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率显著低于对照组,差异有统计学意义(P<0.05)。结论腹腔镜下行改良Soave术治疗新生儿先天性巨结肠的疗效显著,且安全性高。

改良Soave’s术式在小儿结、直肠息肉疾病中的应用(附26例报告)

目的：手术治疗小儿结直肠息肉疾病，方法：应用改良Soave′s手术治疗小儿结直肠息肉疾病26例，内括约肌城形术11例，结果：随访1－8年，无息肉复发，肛门恢复功能优良率92．3％，结论：改良。Soave′s手术治疗小儿结直肠息肉疾病中具有手术方便、损伤小，治疗彻底，疗效明显等优点。

基于S-Procedure的分段线性Delta算子系统的稳定性分析

本文研究了一类由Delta算子描述的分段线性系统的二次稳定性问题。基于Delta域的Lyapunov稳定性理论,利用S-procedure构造了分段Lyapunov函数,而且将分段线性Delta算子系统的二次稳定性判定问题转化为一组线性矩阵不等式的求解问题。

Single center experience in selecting the laparoscopic Frey procedure for chronic pancreatitis

AIM: To share our experience regarding the laparoscopic Frey procedure for chronic pancreatitis(CP) and patient selection.METHODS: All consecutive patients undergoingduodenum-preserving pancreatic head resection from July 2013 to July 2014 were reviewed and those undergoing the Frey procedure for CP were included in this study. Data on age, gender, body mass index(BMI), American Society of Anesthesiologists score, imaging findings, inflammatory index(white blood cells, interleukin(IL)-6, and C-reaction protein), visual analogue score score during hospitalization and outpatient visit, history of CP, operative time, estimated blood loss, and postoperative data(postoperative mortality and morbidity, postoperative length of hospital stay) were obtained for patients undergoing laparoscopic surgery. The open surgery cases in this study were analyzed for risk factors related to extensive bleeding, which was the major reason for conversion during the laparoscopic procedure. Age, gender, etiology, imaging findings, amylase level, complications due to pancreatitis, functional insufficiency, and history of CP were assessed in these patients.RESULTS: Nine laparoscopic and 37 open Frey procedures were analyzed. Of the 46 patients, 39 were male(85%) and seven were female(16%). The etiology of CP was alcohol in 32 patients(70%) and idiopathic in 14 patients(30%). Stones were found in 38 patients(83%). An inflammatory mass was found in five patients(11%). The time from diagnosis of CP to the Frey procedure was 39 ± 19(9-85) mo. The BMI of patients in the laparoscopic group was 20.4 ± 1.7(17.8-22.4) kg/m2 and was 20.6 ± 2.9(15.4-27.7) kg/m2 in the opengroup. Allpatientsrequired analgesic medication for abdominal pain. Frequent acute pancreatitis or severe abdominal pain due to acute exacerbation occurred in 20 patients(43%). Pre-operative complications due to pancreatitis were observed in 18 patients(39%). Pancreatic functional insufficiency was observed in 14 patients(30%). Two laparoscopic patients(2/9) were converted. In seven successful laparoscopic cases, the mean operative time was 323 ± 29(290-370) min. Estimated intra-operativeblood loss was 57 ± 14(40-80) m L. One patient had a postoperative complication, and no mortality was observed. Postoperative hospital stay was 7 ± 2(5-11) d. Multiple linear regression analysis of 37 open Frey procedures showed that an inflammatory mass(P < 0.001) and acute exacerbation(P < 0.001) were risk factors for intra-operative blood loss. CONCLUSION: The laparoscopic Frey procedure for CP is feasible but only suitable in carefully selected patients.

What operation for recurrent rectal prolapse after previous Delorme's procedure? A practical reality

AIM: To report our experience with perineal repair(Delorme's procedure) of rectal prolapse with particular focus on treatment of the recurrence.METHODS: Clinical records of 40 patients who underwent Delorme's procedure between 2003 and 2014 were reviewed to obtain the following data: Gender; duration of symptoms, length of prolapse, operation time, ASA grade, length of post-operative stay, procedure-related complications, development and treatment of recurrent prolapse. Analysis of post-operative complications, rate and time of recurrence and factors influencing the choice of the procedure for recurrent disease was conducted. Continuous variables were expressed as the median with interquartile range(IQR). Statistical analysis was carried out using the Fisher exact test.RESULTS: Median age at the time of surgery was 76 years(IQR: 71-81.5) and there were 38 females and 2 males. The median duration of symptoms was 6 mo(IQR: 3.5-12) and majority of patients presented electively whereas four patients presented in the emergency department with irreducible rectal prolapse. The median length of prolapse was 5 cm(IQR: 5-7), median operative time was 100 min(IQR: 85-120) and median post-operative stay was 4 d(IQR: 3-6). Approximately16% of the patients suffered minor complications such as- urinary retention, delayed defaecation and infected haematoma. One patient died constituting postoperative mortality of 2.5%. Median follow-up was 6.5 mo(IQR: 2.15-16). Overall recurrence rate was 28%(n = 12). Recurrence rate for patients undergoing an urgent Delorme's procedure who presented as an emergency was higher(75.0%) compared to those treated electively(20.5%), P value 0.034. Median time interval from surgery to the development of recurrence was 16 mo(IQR: 5-30). There were three patients who developed an early recurrence, within two weeks of the initial procedure. The management of the recurrent prolapse was as follows: No further intervention(n = 1), repeat Delorme's procedure(n = 3), Altemeier's procedure(n = 5) and rectopexy with faecal diversion(n = 3). One patient was lost during follow up.CONCLUSION: Delorme's procedure is a suitable treatment for rectal prolapse due to low morbidity and mortality and acceptable rate of recurrence. The management of the recurrent rectal prolapse is often restricted to the pelvic approach by the same patientrelated factors that influenced the choice of the initial operation, i.e., Delorme's procedure. Early recurrence developing within days or weeks often represents a technical failure and may require abdominal rectopexy with faecal diversion.

Primary colon resection or Hartmann's procedure in malignant left-sided large bowel obstruction? The use of stents as a bridge to surgery

There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction.Primary resection and anastomosis offers the advantages of a definite procedure without need for further surgery.Its main disadvantages are related to the increased technical challenge and to the potential higher risk of anastomotic leakage that occurs in the emergency setting.Primary resection with end colostomy(Hartmann's procedure) is considered the safer option.Tan et al compared in a systematic review and meta-analysis the use of self-expanding metallic stents(SEMS) as a bridge to surgery vs emergency surgery in the management of acute malignant left-sided large bowel obstruction.The authors concluded that the technical and clinical success rates for stenting were lower than expected.SEMS was associated with a high incidence of clinical and silent perforation.Stenting instead of loop colostomy can be recommended only if the appropriate expertise is available in the hospital.The goal of stenting,a decrease of the stoma rate,may be advocated only if the complication rates of stenting are lower than those of stoma creation in the emergency situation.Until now,this was not demonstrated in a prospective randomized trial.

Khubchandani's procedure combined with stapled posterior rectal wall resection for rectocele

BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has been accepted as the gold-standard procedure. Stapled transanal rectal resection(STARR) has been widely used. However, there are still some disadvantages in this procedure and its effectiveness in anterior wall repair is doubtful. Therefore, new procedures are expected to further improve the treatment of rectocele.AIM To evaluate the efficacy and safety of a novel rectocele repair combining Khubchandani's procedure with stapled posterior rectal wall resection.METHODS A cohort of 93 patients were recruited in our randomized clinical trial and were divided into two different groups in a randomized manner. Forty-two patients(group A) underwent Khubchandani's procedure with stapled posterior rectal wall resection and 51 patients(group B) underwent the STARR procedure.Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.RESULTS In group A, 42 patients underwent Khubchandani's procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis. In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. Mean operative duration was 41.47 ± 6.43 min(group A) vs39.24 ± 6.53 min(group B). Mean hospital stay was 3.15 ± 0.70 d(group A) vs 3.14± 0.54 d(group B). Mean blood loss was 10.91 ± 2.52 mL(group A) vs 10.14 ± 1.86 m L(group B). Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean depth of rectocele decreased from 4.32 ± 0.96 cm(group A) vs 4.18 ± 0.95 cm(group B) preoperatively to 1.19 ± 0.43 cm(group A) vs 1.54 ± 0.82 cm(group B)one year after operation. No other serious complications, such as rectovaginal fistula, perianal sepsis, or deaths, were recorded. After 12 mo of follow-up, 30 patients'(30/34, 88.2%) final outcomes were judged as effective and 4(4/34,11.8%) as moderate in group A, whereas in group B, 30(30/37, 81.1%) patients' outcomes were judged as effective, 5(5/37, 13.5%) as moderate, and 2(2/37,5.4%) as poor.CONCLUSION Khubchandani's procedure combined with stapled posterior rectal wall resection is an effective, feasible, and safe procedure with minor trauma to rectocele.

腹腔镜下辅助经肛门改良Soave术Ⅰ期治疗小儿先天性巨结肠的近期疗效及影响痊愈的危险因素分析

目的探讨腹腔镜下辅助经肛门改良Soave术Ⅰ期治疗小儿先天性巨结肠近期疗效及影响痊愈的相关因素。方法回顾性分析2016年8月—2019年2月本院收治的92例先天性巨结肠患儿的临床资料,根据手术方法不同分为对照组44例和观察组48例,观察组给予腹腔镜下经肛门改良Soave术,对照组给予肛门改良Soave术。对比2组手术指标、近期疗效,分析影响患儿术后痊愈的相关因素。结果观察组手术时间、住院时间、胃肠功能恢复时间短于对照组,术中出血量少于对照组(P<0.01)。观察组术后并发症总发生率低于对照组(P<0.05)。观察组术后6、12个月肛门功能总优良率高于对照组(P<0.05)。吻合口狭窄、肠炎、腹胀是影响先天性巨结肠患儿术后近期痊愈的独立危险因素(P<0.05)。结论对先天性巨结肠患儿采用腹腔镜辅助下经肛门改良Soave术Ⅰ期治疗,可减少术后并发症,改善肛门功能。吻合口狭窄、合并肠炎、合并腹胀为影响患儿术后近期痊愈的独立危险因素。