腹腔镜辅助与开腹Soave术治疗小儿先天性巨结肠的疗效分析
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摘要
目的:探讨腹腔镜辅助Soave术治疗小儿长段型及不能单纯经肛门Soave手术治疗的常见型先天性巨结肠的有效性与安全性。方法:回顾分析62例先天性巨结肠患儿的临床资料,患儿分别行腹腔镜辅助Soave手术(腹腔镜组,n=30)与传统开腹Soave手术(开腹组,n=32)。结果:两组手术时间、单种并发症发生率差异无统计学意义(P>0.05);腹腔镜组术中出血量、术后首次排气排便时间、住院时间、术后并发症总发生率优于开腹组(P<0.05),腹腔镜组住院费用偏高(P<0.05)。结论:腹腔镜辅助Soave手术治疗长段型及不能单纯经肛门Soave手术治疗的常见型先天性巨结肠是安全、有效的。对于常见型巨结肠,可先行经肛门Soave术,必要时选择腹腔镜辅助。
Objective:To investigate the therapeutic effects and safety of laparoscopic-assisted Soave for long-segment type and common type Hirschsprung disease children who cannot accept simple transanal Soave. Methods:A retrospective study was performed on the clinical data of 62 children with Hirschsprung disease. The 62 patients were divided into laparoscopy group( n = 30) and open group( n = 32). Results:There were no significant differences between the two groups in the operative time and postoperative individual complication( P > 0. 05). Compared with open group,laparoscopy group was associated with more hospital costs( P < 0. 05),but significantly less intraoperative bleeding,shorter intestine peristalsis recovery time and hospital stay and fewer incidence of postoperative total complications( P < 0. 05). Conclusions:Laparoscopic-assisted Soave is safe and effective for long-segment type Hirschsprung disease and common type which cannot accept simple transanal Soave in children. First transanal Soave is suggested for the common type Hirschsprung disease,if necessary,laparoscopic-assisted Soave is an alternative.
Objective:To investigate the therapeutic effects and safety of laparoscopic-assisted Soave for long-segment type and common type Hirschsprung disease children who cannot accept simple transanal Soave. Methods:A retrospective study was performed on the clinical data of 62 children with Hirschsprung disease. The 62 patients were divided into laparoscopy group( n = 30) and open group( n = 32). Results:There were no significant differences between the two groups in the operative time and postoperative individual complication( P > 0. 05). Compared with open group,laparoscopy group was associated with more hospital costs( P < 0. 05),but significantly less intraoperative bleeding,shorter intestine peristalsis recovery time and hospital stay and fewer incidence of postoperative total complications( P < 0. 05). Conclusions:Laparoscopic-assisted Soave is safe and effective for long-segment type Hirschsprung disease and common type which cannot accept simple transanal Soave in children. First transanal Soave is suggested for the common type Hirschsprung disease,if necessary,laparoscopic-assisted Soave is an alternative.
引文
[1]张小华,朱天琦,张文,等.经脐腹腔镜与常规腹腔镜治疗先天性巨结肠的疗效观察[J].中华实用儿科临床杂志,2013,28(5):395-397.
[2]王世平,段卫星.腹腔镜辅助下经肛门改良Soave术治疗常见型先天性巨结肠的疗效[J].中华实用儿科临床杂志,2017,32(4):316-317.
[3]夏顺林,李柄,胡晓婷.腹腔镜辅助Soave巨结肠根治术115例[J].临床小儿外科杂志,2014,13(6):529-531.
[4]Drossman DA,Sandler RS,Mc Kee DC,et al.Bowel patterns among subjects not seeking health care.Use of a questionnaire to identify a population with bowel dysfunction[J].Gastroenterology,1982,83(3):529-534.
[5]Holschneider A,Hutson J,Pe1a A,et al.Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations[J].J Pediatr Surg,2005,40(10):1521-1526.
[6]Elhalaby EA,Coran AG,Blane CE,et al.Enterocolitis associated with Hirschsprung's disease:a clinical-radiological characterization based on 168 patients[J].J Pediatr Surg,1995,30(1):76-83.
[7]Reding R,de Ville de Goyet J,Gosseye S,et al.Hirschsprung's disease:a 20-year experience[J].J Pediatr Surg,1997,32(8):1221-1225.
[8]陈锐源,李伟坚,李志雄,等.腹腔镜辅助经肛门改良Soave术治疗先天性巨结肠效果分析[J].白求恩医学杂志,2017,15(3):320-322.
[9]汤绍涛,王国斌.腹腔镜辅助与单纯经肛门手术行一期Soave拖出术治疗先天性巨结肠的对比研究[J].腹腔镜外科杂志,2009,14(10):745-748.
[10]孟文,康超.腹腔镜治疗小儿食管裂孔疝的疗效分析[J].腹腔镜外科杂志,2017,22(2):102-104.
[11]石元同,张思德.腹腔镜与微创小切口手术治疗小儿腹股沟疝的临床疗效比较[J].腹腔镜外科杂志,2017,22(2):105-107.
[12]郑百俊,王怀杰,高亚,等.腹腔镜辅助根治长段型巨结肠远期疗效观察[J].中华小儿外科杂志,2015,36(11):824-828.
[13]廖晓锋,杜明国,张永康,等.保留扩张结肠的腹腔镜辅助先天性巨结肠根治术[J].腹腔镜外科杂志,2009,14(10):749-750.
[14]Papandreou E,Baltogiannis N,Cigliano B,et al.Transanal endorectal pull-through with or without laparoscopic assistance?Development of an experimental model[J].Pediatr Med Chir,2004,26(4):253-235.
[2]王世平,段卫星.腹腔镜辅助下经肛门改良Soave术治疗常见型先天性巨结肠的疗效[J].中华实用儿科临床杂志,2017,32(4):316-317.
[3]夏顺林,李柄,胡晓婷.腹腔镜辅助Soave巨结肠根治术115例[J].临床小儿外科杂志,2014,13(6):529-531.
[4]Drossman DA,Sandler RS,Mc Kee DC,et al.Bowel patterns among subjects not seeking health care.Use of a questionnaire to identify a population with bowel dysfunction[J].Gastroenterology,1982,83(3):529-534.
[5]Holschneider A,Hutson J,Pe1a A,et al.Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations[J].J Pediatr Surg,2005,40(10):1521-1526.
[6]Elhalaby EA,Coran AG,Blane CE,et al.Enterocolitis associated with Hirschsprung's disease:a clinical-radiological characterization based on 168 patients[J].J Pediatr Surg,1995,30(1):76-83.
[7]Reding R,de Ville de Goyet J,Gosseye S,et al.Hirschsprung's disease:a 20-year experience[J].J Pediatr Surg,1997,32(8):1221-1225.
[8]陈锐源,李伟坚,李志雄,等.腹腔镜辅助经肛门改良Soave术治疗先天性巨结肠效果分析[J].白求恩医学杂志,2017,15(3):320-322.
[9]汤绍涛,王国斌.腹腔镜辅助与单纯经肛门手术行一期Soave拖出术治疗先天性巨结肠的对比研究[J].腹腔镜外科杂志,2009,14(10):745-748.
[10]孟文,康超.腹腔镜治疗小儿食管裂孔疝的疗效分析[J].腹腔镜外科杂志,2017,22(2):102-104.
[11]石元同,张思德.腹腔镜与微创小切口手术治疗小儿腹股沟疝的临床疗效比较[J].腹腔镜外科杂志,2017,22(2):105-107.
[12]郑百俊,王怀杰,高亚,等.腹腔镜辅助根治长段型巨结肠远期疗效观察[J].中华小儿外科杂志,2015,36(11):824-828.
[13]廖晓锋,杜明国,张永康,等.保留扩张结肠的腹腔镜辅助先天性巨结肠根治术[J].腹腔镜外科杂志,2009,14(10):749-750.
[14]Papandreou E,Baltogiannis N,Cigliano B,et al.Transanal endorectal pull-through with or without laparoscopic assistance?Development of an experimental model[J].Pediatr Med Chir,2004,26(4):253-235.