经肛门手术与传统剖腹手术对巨结肠患儿术后应激反应的对比研究经肛门手术与传统剖腹手术对巨结肠患儿术后应激反应的对比研究

目的：探讨经肛门巨结肠根治术与传统剖腹手术对先天性巨结肠患儿手术创伤程度的差别。方法．30例患儿随机分为经肛门组及剖腹手术组各15例。每例患儿于术前24h、术后24h、72h清晨空腹抽取静脉血,用ELISA法测量血清中IL-6的浓度,应用速率散射比浊法测量C反应蛋白的浓度,并对检测结果进行统计学处理。结果：两组患儿术后白细胞介素-6（IL-6）及C反应蛋白均较术前有明显变化（P〈0．05）。经肛门组IL-6、C反应蛋白浓度在术后24h及72h均较剖腹组要低（P〈0．05）。结论：经肛门巨结肠根治术较传统剖腹手术对先天性巨结肠患儿所造成的手术创伤程度要小。     

先天性巨结肠经肛门手术患儿的护理

我院2001年10月-2003年4月共收治先天性巨结肠12例，均行经肛门巨结肠根治术。该手术在腹部没有切口，术后疼痛较轻，治疗效果较好。护理体会报告如下。     

经肛门巨结肠根治术5例

20 0 2年 1月至 2 0 0 2年 5月 ,我科采用经肛门巨结肠根治术治疗小儿先天性巨结肠症 4例 ,乙状结肠冗长症 1例 ,近期效果良好 ,现报告如下。1　临床资料4例巨结肠患儿均为男性 ,年龄分别为 2 1 d、4 0 d、4个月、1 0个月。均有胎粪排出延迟 ,反复便秘 ,腹胀病史 ,均经钡灌肠检查证实为常见型巨结肠 ,1例乙状结肠冗长症 ,为女性 ,7岁。术前常规来回灌肠 7～ 1 4 d,术前有贫血和低蛋白血症者予以纠正 ,术前 3d口服抗菌药物作肠道准备。2　手术方法基础麻醉加骶管麻醉 ,留置导尿管 ,取膀胱截石位 ,气管拉钩拉开肛门 ,显露齿状线后 ,用 0 / 3丝…     

经肛门巨结肠根治术的手术配合

先天性巨结肠是最常见的消化道神经结细胞发育障碍，表现为直肠或结肠神经细胞减少或缺如。在婴幼儿中发病率最高(1：2000～5000)，男性多于女性(4：1)。Soave改良法治疗巨结肠是目前极具有应用前景的外科微创新手术，与传统的开腹手术相比，损伤小、恢复快、肠道干扰小、病人术后痛苦少、下床活动早等     

先天性巨结肠经肛门拖出术患儿护理进展

目的 探讨先天性巨结肠经肛门拖出术患儿的护理方法及进展.方法 对16例先天性巨结肠患者经肛门拖出术后的护理进行回顾分析.结果16例患者均痊愈出院,且无一例并发症发生.结论 小儿先天性巨结肠患者采用肛门拖出术治疗具有很好的疗效,正确有效的护理是促使患儿恢复健康的重要因素.     

经肛门巨结肠改良根治术的临床应用

目的：总结经肛门巨结肠改良根治术的应用经验。方法：10例经钡灌肠检查诊断为先天性巨结肠患儿行经肛门巨结肠根治术;3例采用De la Torte术式,7例行改良术式。经肛门切开直肠粘膜,后壁齿状线上1cm,前壁齿状线上2-3cm,向近端游离达腹腔水平后,切开直肠肌鞘,切除腹膜外直肠肌鞘达肛提肌水平,残留肌鞘后壁“V”形切除,游离近端结肠,拖出正常结肠与肛门斜形吻合。结果：3例行传统术式患儿近期出现小肠结肠炎,经治疗痊愈。7例行改良术式患儿无近期并发症。全组病例随诊2个月至1年无便失禁,排便2～5次／d。结论：经肛门改良巨结肠根治术是一种安全有效,手术创伤小的术式,值得1临床推广应用。     

经肛门结肠拖出术治疗常见型巨结肠

先天性巨结肠根治手术由繁变简,即由经腹途径改为腹腔镜辅助或经肛门手术,不但减少手术创伤、并发症,而且康复快,减少了家长的经济负担.我院自2003年1月至9月行经肛门结肠拖出术治疗常见型先天性巨结肠9例,现就其手术要点、疗效及短期随访结果报告如下.     

经肛门根治小儿先天性巨结肠的手术配合

对我院168例经肛门进行小儿先天性巨结肠根治的手术配合，同时做好患儿家长的心理护理，术中认真观察病情，对手术成功与术后恢复至关重要。经肛门根治先天性巨结肠手术时间短，创伤小，出血少，恢复快，患儿手术年龄提前，减轻了患儿的痛苦及家长的负担，治疗效果好，提高了患儿的生活质量。     

先天性巨结肠术后肛门护理的临床对比

目的探讨3M无痛保护膜与红外线烤灯在先天性巨结肠术后肛门护理中的应用对比。方法将160例行先天性巨结肠术后的患儿随机分成两组,其中对照组80例,患儿术后拔除肛管后肛门用生理盐水棉球擦拭和红外线灯烤进行护理,实验组80例,患儿术后拔除肛管后用3M无痛保护膜喷涂肛门皮肤,并进行暴露。结果实验组使用3M无痛保护膜在皮肤潮红方面与对照组比较有较好的作用（P=0.001）,起到了有效保护皮肤及促进皮肤愈合的目的 ,可有效增加患儿的舒适度,减轻护理人员及家属的负担,提高患儿及家属的满意度,两组患儿家属主观感受评分比较差异均有统计学意义（均P〈0.05）。结论 3M无痛保护膜方便实用,可广泛应用于临床护理工作。     

经肛巨结肠根治术后排便功能调查及临床评价

时58例经肛门巨结肠根治术后6个月以上儿童进行随访并进行排便功能问卷调查，对所有患儿的手术年龄、随访时间和切除肠段长度等影响因素进行回顾，探讨经肛门巨结肠根治术后中远期排便功能。经肛门巨结肠根治术后排便功能多数良好．排便功能随着术后随访时间的延长而逐渐恢复，手术年龄越小术后排便功能恢复越快；痉挛段长度越长，排便功能障碍的发生率越高。     

小儿先天性心脏病手术治疗体会

目的:总结小儿先天性心脏病手术治疗经验。方法:对42例小儿先天性心脏病的临床资料进行回顾性分析。结果:42例小儿先天性心脏病患者施行根治性手术治疗,死亡1例,病死率2.3%。结论:选择适合的手术方式,不断改进和提高体外循环技术、手术技巧,加强呼吸道管理,可降低手术风险,提高疗效。     

经肛门Ⅰ期巨结肠根治术5例报告

先天性巨结肠 (Hirschsprung's disease,HD)是小儿常见的消化道畸形 ,手术是唯一治疗方法 ,常规术式需开腹切除病变肠管。我院 2 0 0 2年 1月～ 2 0 0 3年 1月采用不开腹巨结肠根治术 5例 ,取得初步满意效果。1　临床资料1.1　一般资料　本组 5例 ,男性 4例 ,女性 1例 ,年龄 7.8±4 .5 6个月 (3～ 2 6个月 )。临床表现为出生后排胎便延迟 (>36h) ,排便困难。钡灌肠检查示普通型巨结肠 4例 ,短段型 1例。术前准备每日温盐水回流洗肠一次共 2周。术前 3d口服灭滴灵、庆大霉素。1.2　手术方式　采用基础麻醉加骶管麻醉 ,膀胱截石位 ,留置导尿…     

维吾尔族男性冠心病患者CRP、FBG、IL-6水平变化及相关分析

目的:探讨维吾尔族男性冠心病患者血清C-反应蛋白(CRP)、白介素-6(IL-6)和血浆纤维蛋白原(FBG)的变化及相互关系。方法:选取45例冠心病患者(冠心病组)及30例健康体检者(正常对照组),采血检测CRP、FBGI、L-6水平,并进行对照分析。结果:冠心病组CRP为(5.86±3.28)mg/L,FBG为(4.17±1.35)g/L,IL-6为(151.08±26.72)ng/L,均较对照组明显增高(P均<0.01)。对照组CRP、FBGI、L-6均无相关性(P>0.05);冠心病组IL-6与CRP及FBG均呈正相关(P均<0.01,r分别为0.67、0.65、0.86)。结论:血清IL-6、CRP及血浆FBG增高是冠心病独立危险因素,均与冠心病的发生、发展有密切关系,3项指标有很好的相关性。     

经肛门Ⅰ期巨结肠根治术预后因素的探讨

目的对经肛门Ⅰ期巨结肠根治术预后因素进行探讨,以期为临床治疗提供依据。方法对经肛门Ⅰ期巨结肠根治术治疗的患儿177例,将其原始资料按统一标准列表、赋值,以其根治术后便秘、术后小肠结肠炎作为自变量,将其他因素作为应变量,采用多元回归法分析其根治术预后与其他因素之间的关系。结果先天性巨结肠经肛门Ⅰ期根治术便秘可能与后鞘切除范围、黏膜剥离位置、吻合口狭窄及手术年龄有关;术后小肠结肠炎可能与后鞘切除范围、黏膜剥离位置、吻合口狭窄及术前是否存在小肠结肠炎有关。结论经肛门Ⅰ期巨结肠根治术手术后主要与术中病变肠管及后鞘切除范围、黏膜残留、手术年龄,以及正确术前诊断有关,选择合适手术时机,正确处理后鞘及黏膜是提高治愈率的关键。     

A new modification of transanal Soave pull-throug procedure for Hirschsprung＇s disease

Background One stage transanal Soave pull-through procedure (TSPP) is a recent popular operation in the treatment of Hirschsprung's disease (HD). W ith no visible scar and a short hospital stay, it is well accepted by surgeons and mothers. In the conventional Soave procedure, a long rectal muscular cuff left for anocolic anastomosis might increase the incidence of postoperative enterocolitis and constipation. This study presents a modified transanal Soave pull-through procedure (MTSPP) which includes an oblique mucosectomy and an oblique anastomosis with a short split muscular cuff.Methods A review of two groups of HD patients was made: 112 underwent conventional transanal Soave procedure from 1999 to 2001 (group 1) and 140 underwent modified transanal Soave procedure from 2002 to 2004 (group 2). A comparison was made between the two groups on operative data and postoperative complications. The data included: age at the operation, operating time, blood loss, time to feeds and hospital stay, occurrence of postoperative enterocolitis or constipation, need for anal dilatation, postoperative bowel function and perianal skin problems. Results There was no significant difference between two groups with respect to age, gender, length of colon resected, operating time, blood loss and hospital stay. However occurrence of postoperative enterocolitis, constipation, anastomotic stricture and time needed for anal dilatation were evidently less in group 2 (MTSPP). The m ean operating time i n group 1 was ( 106 ± 39) minutes with a range of 60 to 170 minutes; in group 2 was (101 ± 36) minutes with a range of 66 to 190 minutes. The average length of the bowel resected in group 1 was (24 ± 7) cm, range 15 to 58 cm; in group 2 was (26 ± 8) cm, range 15 to 70 cm. Two patients, one in each group, required l aparoscopic assistance because of long aganglionic colon. Another patient in group 2 required laparotomy because of total colonic aganglionosis. Postoperative complications in group 1 included: temporary perianal excoriation in 34 patients (26 were &lt;3 months of age), enterocolitis in 21, anastomotic stricture in 11, recurrent constipation in 12, cuff abscess in 1, anastomosis leak in 1, soiling in 3 and rectal prolapse in 1. In group 2 post operative complications included: transient perianal excoriation in 37 patients (30 were &lt;3 months of age), enterocolitis in 13, anastomotic stricture in 5, recurrent constipation in 6, anastomotic leak in 1, adhesive bowel obstruction in 1 and soiling in 4. Complete bowel continence was found in 97 children (86.6%) in group 1 and in 129 children (92.1%) in group 2 at one year followup after operation.Conclusions Modified transanal Soave pull-through procedure for HD with oblique mucosectomy and anastomosis and a short split muscular cuff is a safe and feasible operation with low incidence of postoperative complication. It is an encouraging improvement of the conventional transanal Soave pull-through procedure. MTSPP is a preferable choice in the surgery of HD. Chin Med J 2006; 119(1):37-42     

A new modification of transanal Swenson pull-through procedure for Hirschsprung’s disease

Background The one-stage pull-through procedures for Hirschsprung＇s disease （HD） have become popular because it is well accepted by surgeons and mothers with no visible scar and a short hospital stay. It represents the latest development in the concept of a minimally invasive surgery for HD. We introduce a new method of transanal one-stage pull-through for Hirschsprung＇s disease, different from the transanal Scare procedure.
Methods One hundred and thirty-four patients aged 9 days to 5 years underwent a transanal one-stage pull-through procedure. The diagnosis was definite by barium enema or rectal biopsies preoperatively. The patients were anesthetized and placed in the lithotomy position. A urinary catheter was optional. Giving anorectal dilatations for half a minute, a pull-through of the rectum above the peritoneal reflection and into the intussusception was performed. Fine silk suturing was performed circumferentially at the level of that point which was used for traction for the distal end. Another circumferential suture was performed parallel 0.5 cm distance above the original one and used for traction for the proximal intestines. The full-thickness rectal wall was truncated between the above two circumferential sutures with cautery. The proximal intestines were pulled down and the mesenteric vessels were dissected with ligation until normal intestines were accessed; the presence of ganglion cells was determined by intraoperative rapid frozen section. The distal end was dissected anteriorly 2.5-3.5 cm above the dentate line. The posterior rectal wall was split longitudinally and dissected to a point 0.5-1.0 cm above the dentate line. The segment of the lesion was resected. The length of bowel resected ranged from 12 to 50 cm （median 16.5 cm）. An oblique anastomosis was made.
Results The mean operating time was 70 minutes. Postoperative rectal dilation was not required. The patient tolerated feeding on the first postoperative day. Eighty-eight patients were followed-up. All these patients ha     

A new modification of transanal Soave pull-through procedure for Hirschsprung''s disease

SINGLE STAGE TRANSANAL SOAVE PULL-THROUGH PROCEDURE (TSPP) REPRESENTS AN IMPROVEMENT IN THE SENSE OF MINIMAL INVASIVE SURGERY FOR HIRSCHSPRUNG’S DISEASE (HD).1 IT HAS BEEN RAPIDLY POPULARIZED IN MANY CENTRES SINCE IT WAS PUBLISHED BY DE LA TORRE-MONDRAGON IN 1998.2 IN CONVENTIONAL SOAVE PROCEDURE, A LONG RECTAL MUSCULAR CUFF(5 TO 7 CM) WAS LEFT FOR ANOCOLIC SANASTOMOSIS, WHIC…     

腹腔镜与开腹手术治疗宫外孕的疗效对比

目的:比较腹腔镜与开腹手术治疗宫外孕的临床疗效。方法:将2008年2月～2011年2月本院住院治疗的160例宫外孕患者随机分入观察组(腹腔镜组)与对照组(开腹手术组),每组各80例,比较两组临床疗效及术后恢复情况。结果:观察组手术时间(50.68±8.26)显著少于对照组(80.26±11.29);两组术中出血量分别为(35.42±6.25)mL与(86.35±11.82)mL,观察组显著少于对照组(P<0.05);观察组肛门排气时间、常规留置尿管时间、下床活动时间及平均住院天数显著少于对照组(P<0.05);观察组患者术后恢复正常工作生活时间显著少于对照组(P<0.05)。结论:相对于开腹手术,腹腔镜治疗宫外孕具有疗效确切、对机体损伤小,患者恢复快的特点。