腹腔镜辅助 Soave 巨结肠根治术115例

目的探讨腹腔镜辅助 Soave 巨结肠根治术的疗效及并发症的防治。方法回顾性分析本院2008—2013年收治的115例先天性巨结肠患儿临床资料，均行腹腔镜辅助 Soave 巨结肠根治术，其中男81例，女34例，年龄1个月至14岁，短段型24例，常见型72例，长段型11例，全结肠型8例。结果115例患儿手术均获成功，手术时间60-120 min，平均（95．70±14．17）min，术中出血量3-8 mL，平均（4．8±1．65）mL，术后近期大便5-12次，3-6个月后大便接近正常，每日2-5次，术后发生小肠结肠炎10例，污粪15例，便秘复发2例，吻合口瘘结肠回缩1例，肛周皮炎15例，肛门狭窄3例。结论腹腔镜辅助 Soave 巨结肠根治术治疗小儿先天性巨结肠创伤小，操作简单，安全有效，但也存在一定的并发症。术前诊断、术中术后规范处理，可减少术后并发症的发生。

The prevention and management of postoperative complications in the laparoscopic-assisted Soave radi-cal macrosigmoid operation

Objetive To study the complications and explore their prevention and treatment in the lapa-roscopic-assisted Soave radical macrosigmoid operation. Methods A retrospective review was made on the clinical data of 115 children （81 males and 34 females）who suffered from congenital megacolon and underwent laparoscopic-assisted Soave radical operation.Their age range from 1 month to 14 years.Among the total 115 cases,24 were of short type,72 common type,11 long type,and 8 total colonic type. Results All the 115 patients received successful operation with the mean operative time（95.70 ±14.17）min（range 60 to 120 min）.The mean blood loss was （4.8 ±1.65）mL（range 3 -8 mL）.The frequency of defecation shortly after the operation was 5 -12 times per day,defecation was almost normal 3 -6 months after operation （2 -5 times per day）.Postoperative complications included enterocolitis in 10 cases （8.7%）,perianal dermatitis in 15 cases （13.0%）,excrement in 15 cases （13.0%）,recurrent constipation in 2 cases （1.7%）,anastomotic fistula in 1 case （0.8%）,colon retraction in 1 case （0.8%）,and anal stenosis in 3 cases （2.6%）. Con-clusion Laparoscopic-assisted Soave radical operation in treatment of congenital megacolon in child is mini-in-vasive,easy,safe,effective and has better cosmetic result.Yet some complications,especially those of the long type and the total colonic type,may occur.Preoperative diagnosis,intraoperative and postoperative stand-ardized processing can reduce the postoperative complications.