快速康复外科联合腹腔镜技术治疗婴儿先天性巨结肠

目的：评估快速康复外科（FTS）理念联合腹腔镜技术治疗婴儿先天性巨结肠的安全性及临床效果。方法回顾性分析南京医科大学附属南京儿童医院新生儿外科2010年6月至2013年6月接受择期手术治疗的72例年龄为2．5～5．0月的先天性巨结肠患儿的临床资料，根据家长意愿，其中33例予以快速康复外科理念指导下联合腹腔镜手术（FTS组），39例予以单纯腹腔镜手术（对照组），比较两组患儿手术以及术后肠功能恢复时间、总住院时间、住院费用和并发症发生率等情况。结果 FTS组与对照组患儿术中出血和手术时间比较，差异无统计学意义（均P＞0．05）。术后肠功能恢复时间FTS组（42±9） d，对照组（46±8） d；虽两组差异无统计学（P＝0．078），但FTS组要快于对照组。FTS组总住院时间为（10±2） d，住院费用（15316±2273）元，明显低于对照组的（14±4） d和（18641±3082）元（P＜0．01）。随访4周，两组术后并发症发生率和术后恢复情况比较，差异均无统计学意义（P＞0．05）。结论快速康复外科理念联合腹腔镜技术治疗婴儿先天性巨结肠安全、有效。

Fast track surgery combined with laparoscopy in the treatment of infant Hirschsprung disease

Objective To evaluate the safety and efficacy of fast track surgery （FTS） combined with laparoscopy in the treatment of infant Hirschsprung disease. Methods Clinical data of 72 infants with Hirschsprung disease undergoing elective pull-through surgery from June 2010 to June 2013 were retrospectively summarized. The patients were divided into two groups： fast track surgery combined with laparoscopy group （FTS group, n=33） and laparoscopic surgery with traditional management perioperatively （control group, n=39）. Postoperative intestinal function recovery, hospital stay, cost of hospitalization, complications were compared and postoperative recovery was followed-up for four weeks. Results There were no significant differences in intraoperative blood loss and operative time between FTS and control group（both P〉0.05）. The recovery of bowel movement was earlier in the FTS group but the difference was not statistically significant （P=0.078）. The hospital stay was shorter （10±2） d vs. （14±4） d] and cost of hospitalization was lower（15 316±2273） Yuan vs. （18 641±3082） Yuan] in FTS group than those in control group（P〈0.01）. Postoperative complications and recovery conditions during 4 weeks follow-up were similar between the two groups. Conclusion Fast track surgery combined with laparoscopy in the treatment of infant Hirschsprung disease is safe and effective.