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
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摘要
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.
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.
引文
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[6]石群峰,李新宁,罗树友.腹腔镜辅助Soave根治术治疗小儿先天性巨结肠587例的疗效观察[J].广西医学,2013,35(4):426-429.
[7]郑爱萍.小儿先天性巨结肠的X线检查[J].当代医学,2014,20(12):60-61.
[8]雷英,钟斌,曾繁晟,等.直肠粘膜活检和免疫组化诊断先天性巨结肠[J].赣南医学院学报,2014,34(4):592-594.
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[11]孙小兵,任红霞,陈淑芸,等.经直肠鞘内拖出巨结肠根治术并发症分析[J].中华胃肠外科杂志,2015,18(5):459-462.
[12]李玉峰,浦涧,吕昌恒,等.小儿先天性巨结肠腹腔镜辅助下改良Soave手术的临床治疗效果[J].结直肠肛门外科,2016,22(S1):95-96.
[13]廖凯男,彭强,卞则栋,等.腹腔镜与超声刀配合治疗长段型先天性巨结肠疗效及安全性[J].四川医学,2016,37(7):798-801.
[14]张现伟.265例先天性巨结肠术后发生小肠结肠炎的高危症兆分析[J].中国实用医药,2014,9(3):60-61.
[15]陈志远.新生儿巨结肠免气腹腹腔镜辅助经肛门Soave术11例报告[J].腹腔镜外科杂志,2013,18(4):265-276.
[16]邵雷朋,潘登,谢文雅,等.腹腔镜辅助经肛门Soave治疗新生儿先天性巨结肠36例分析[J].中国医学创新,2016,13(6):112-115.
[17]周丽霞.腹腔镜下行改良Soave术治疗新生儿先天性巨结肠临床分析[J].重庆医学,2014,43(27):3573-3574.
[18]禚保彪,张宏伟,李圆,等.腹腔镜辅助Soave根治术治疗新生儿及2月内小婴儿长段型巨结肠疗效观察[J].中华胃肠外科杂志,2016,19(1):93-94.
[19]石群峰,李新宁.腹腔镜辅助Soave根治术治疗小儿先天性巨结肠的手术并发症及防治措施[J].腹腔镜外科杂志,2013,18(3):177-182.
[2]甄亚琴,徐纪荣.先天性巨结肠的研究进展[J].中国当代医药,2015,22(34):21-24.
[3]王兆阳.经肛门改良Soave术和经腹手术治疗先天性巨结肠的临床疗效及安全性分析[J].中国妇幼保健,2014,29(18):2999-3001.
[4]李卫华,丁娥,牛军,等.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[J].中国现代普通外科进展,2014,17(5):350-352,360.
[5]曾战东,张宏伟,刘丰丽,等.腹腔镜手术治疗新生儿先天性巨结肠的疗效观察[J].腹腔镜外科杂志,2013,18(6):435-437.
[6]石群峰,李新宁,罗树友.腹腔镜辅助Soave根治术治疗小儿先天性巨结肠587例的疗效观察[J].广西医学,2013,35(4):426-429.
[7]郑爱萍.小儿先天性巨结肠的X线检查[J].当代医学,2014,20(12):60-61.
[8]雷英,钟斌,曾繁晟,等.直肠粘膜活检和免疫组化诊断先天性巨结肠[J].赣南医学院学报,2014,34(4):592-594.
[9]蔡威,孙宁,魏光辉.小儿外科学[M].5版.北京:人民卫生出版社,2014:312-319.
[10]王果,李振东.小儿外科手术学[M].2版.北京:人民卫生出版社,2011:339-353.
[11]孙小兵,任红霞,陈淑芸,等.经直肠鞘内拖出巨结肠根治术并发症分析[J].中华胃肠外科杂志,2015,18(5):459-462.
[12]李玉峰,浦涧,吕昌恒,等.小儿先天性巨结肠腹腔镜辅助下改良Soave手术的临床治疗效果[J].结直肠肛门外科,2016,22(S1):95-96.
[13]廖凯男,彭强,卞则栋,等.腹腔镜与超声刀配合治疗长段型先天性巨结肠疗效及安全性[J].四川医学,2016,37(7):798-801.
[14]张现伟.265例先天性巨结肠术后发生小肠结肠炎的高危症兆分析[J].中国实用医药,2014,9(3):60-61.
[15]陈志远.新生儿巨结肠免气腹腹腔镜辅助经肛门Soave术11例报告[J].腹腔镜外科杂志,2013,18(4):265-276.
[16]邵雷朋,潘登,谢文雅,等.腹腔镜辅助经肛门Soave治疗新生儿先天性巨结肠36例分析[J].中国医学创新,2016,13(6):112-115.
[17]周丽霞.腹腔镜下行改良Soave术治疗新生儿先天性巨结肠临床分析[J].重庆医学,2014,43(27):3573-3574.
[18]禚保彪,张宏伟,李圆,等.腹腔镜辅助Soave根治术治疗新生儿及2月内小婴儿长段型巨结肠疗效观察[J].中华胃肠外科杂志,2016,19(1):93-94.
[19]石群峰,李新宁.腹腔镜辅助Soave根治术治疗小儿先天性巨结肠的手术并发症及防治措施[J].腹腔镜外科杂志,2013,18(3):177-182.