改良腹腔镜Swenson与Soave术对儿童短段型先天性巨结肠疗效差异
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摘要
目的对腹腔镜Soave术(LS)和改良腹腔镜Swenson术(MLSw)在儿童短段型巨结肠的治疗效果和并发症进行比较分析。方法回顾分析我科自2007年3月至2016年12月收治的77例儿童短段型巨结肠临床资料。LS术26例,MLSw术51例。收集两组术前、术中和术后临床资料进行分析,随访12~48个月。结果 MLSw组平均手术时间、术中出血量和住院时间比LS组少。两组术后平均进食时间无明显差异。MLSw组术后早期并发症的发生率较LS组低,但两组术后晚期并发症发生率无明显差异。结论 LS和MLSw术都适用于儿童短段型巨结肠的治疗。但MLSw操作更简单,术后早期的排便控制更好。更重要的是,MLSw术可完全切除无神经节细胞肠段,而无需保留直肠肌鞘。
Objective To compare the characteristics,complications and outcomes of the modified lapa-roscopic Swenson(MLSw)and laparoscopic Soave(LS)procedures for children with short-segment Hirschsprungdisease(HD). Methods Seventy-seven pediatric patients with HD who underwent surgery from March 2007 toDecember 2016 were enrolled in this retrospective study. Twenty-six patients were treated with LS and 51 cases un-derwent MLSw. The preoperative,operative and postoperative data was collected,with follow-up periods rangingfrom 12 to 48 months. The perioperative/operative characteristics,postoperative complications,and outcomes werecompared between the two groups. Results On average,the patients in the LS group had a longer operating timethan that in the MLSw group(P < 0.05). Blood loss was significantly less in the MLSw group than that in the LSgroup(P < 0.05). There was no significant difference in feeding time between the two groups(P > 0.05). TheMLSw group was discharged after a shorter hospitalization time than that in the LS group(P < 0.05). The MLSwgroup had lower incidences of postoperative complications than those in the LS group in the early postoperativeperiod,with no significant difference in the rate of complications during the late postoperative period was foundbetween the two groups. Conclusions Both LS and MLSw are suitable for treatment of children with short-segmentHD. However,the MLSw operation is much simpler,with less operating time,less intraoperative blood loss,shorterhospitalization time and better bowel control in the early postoperative period. We favor this approach because itallows complete removal of the entire original aganglionic bowel,without leaving behind a cuff.
Objective To compare the characteristics,complications and outcomes of the modified lapa-roscopic Swenson(MLSw)and laparoscopic Soave(LS)procedures for children with short-segment Hirschsprungdisease(HD). Methods Seventy-seven pediatric patients with HD who underwent surgery from March 2007 toDecember 2016 were enrolled in this retrospective study. Twenty-six patients were treated with LS and 51 cases un-derwent MLSw. The preoperative,operative and postoperative data was collected,with follow-up periods rangingfrom 12 to 48 months. The perioperative/operative characteristics,postoperative complications,and outcomes werecompared between the two groups. Results On average,the patients in the LS group had a longer operating timethan that in the MLSw group(P < 0.05). Blood loss was significantly less in the MLSw group than that in the LSgroup(P < 0.05). There was no significant difference in feeding time between the two groups(P > 0.05). TheMLSw group was discharged after a shorter hospitalization time than that in the LS group(P < 0.05). The MLSwgroup had lower incidences of postoperative complications than those in the LS group in the early postoperativeperiod,with no significant difference in the rate of complications during the late postoperative period was foundbetween the two groups. Conclusions Both LS and MLSw are suitable for treatment of children with short-segmentHD. However,the MLSw operation is much simpler,with less operating time,less intraoperative blood loss,shorterhospitalization time and better bowel control in the early postoperative period. We favor this approach because itallows complete removal of the entire original aganglionic bowel,without leaving behind a cuff.
引文
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[9]赵成鹏,段永福,周晓波,等.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[J].实用医学杂志,2015,31(12):1999-2001.
[10]LEVITT M A,DICKIE B,PENA A.Evaluation and treatmentof the patient with Hirschsprung disease who is not doing wellafter a pull-through procedure[J].Semin Pediatr Surg,2010,19(2):146-153.
[11]王亮,王忠荣,徐兵,等.先天性巨结肠手术切缘Cajal间质细胞分布与术后便秘的关系[J].实用医学杂志,2016,32(1):157-158.
[12]VU P A,THIEN H H,HIEP P N.Transanal one-stage endorec-tal pullthrough for Hirschsprung disease:experiences with 51newborn patients[J].Pediatr Surg Int,2010,26(6):589-592.
[13]TANG W,GENG Q,ZHANG J,et al.Fast track surgery com-bined with laparoscopy in the treatment of infant Hirschsprungdisease[J].Zhonghua Wei Chang Wai Ke Za Zhi,2014,17(8):805-808.
[14]AGGARWAL S K,SINHA S K,RATAN S K,et al.Laparo-scopic or laparoscopic-assisted pelvic surgery in small infants:our experience[J].J Laparoendosc Adv Surg Tech A,2011,21(6):543-548.
[2]LUKAC M,ANTUNOVIC S S,VUJOVIC D,et al.Effective-ness of various surgical methods in treatment of Hirschsprung′sdisease in children[J].Vojnosanit Pregl,2016,73(3):246-250.
[3]SUN S,CHEN G,ZHENG S,et al.Usefulness of posterior sag-ittal anorectoplasty for redo pull-through in complicated and re-current Hirschsprung disease:Experience with a single surgicalgroup[J].J Pediatr Surg,2017,52(3):458-462.
[4]GEORGESON K E,FUENFER M M,HARDIN W D.Primarylaparoscopic pull-through for Hirschsprung′s disease in infantsand children[J].J Pediatr Surg,1995,30(7):1017-1021,1021-1022.
[5]LEVITT M A,HAMRICK M C,ERADI B,et al.Transanal,full-thickness,Swenson-like approach for Hirschsprung disease[J].J Pediatr Surg,2013,48(11):2289-2295.
[6]BING X,SUN C,WANG Z,et al.Transanal pullthroughSoave and Swenson techniques for pediatric patients withHirschsprung disease[J].Medicine(Baltimore),2017,96(10):e6209.
[7]LEVITT M A,MARTIN C A,OLESEVICH M,et al.Hirschsprung disease and fecal incontinence:diagnostic andmanagement strategies[J].J Pediatr Surg,2009,44(1):271-277.
[8]BISCHOFF A,FRISCHER J,KNOD J L,et al.Damaged anal canal as a cause of fecal incontinence after surgical repair forHirschsprung disease-a preventable and under-reported compli-cation[J].J Pediatr Surg,2017,52(4):549-553.
[9]赵成鹏,段永福,周晓波,等.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[J].实用医学杂志,2015,31(12):1999-2001.
[10]LEVITT M A,DICKIE B,PENA A.Evaluation and treatmentof the patient with Hirschsprung disease who is not doing wellafter a pull-through procedure[J].Semin Pediatr Surg,2010,19(2):146-153.
[11]王亮,王忠荣,徐兵,等.先天性巨结肠手术切缘Cajal间质细胞分布与术后便秘的关系[J].实用医学杂志,2016,32(1):157-158.
[12]VU P A,THIEN H H,HIEP P N.Transanal one-stage endorec-tal pullthrough for Hirschsprung disease:experiences with 51newborn patients[J].Pediatr Surg Int,2010,26(6):589-592.
[13]TANG W,GENG Q,ZHANG J,et al.Fast track surgery com-bined with laparoscopy in the treatment of infant Hirschsprungdisease[J].Zhonghua Wei Chang Wai Ke Za Zhi,2014,17(8):805-808.
[14]AGGARWAL S K,SINHA S K,RATAN S K,et al.Laparo-scopic or laparoscopic-assisted pelvic surgery in small infants:our experience[J].J Laparoendosc Adv Surg Tech A,2011,21(6):543-548.