婴儿腹腔镜下结肠次全切除术的临床分析

目的探讨婴儿腹腔镜下结肠次全切除术的可行性。方法回顾性分析2006年3月至2012年3月本院55例婴儿长段型巨结肠（Hirschspmng’s disease，HD）、巨结肠同源病（Hirschsprung’s disease of allieddisorder，HAD）及HD合并HAD，行开腹和腹腔镜下结肠次全切除术患儿的临床资料。其中腹腔镜手术38例，开腹手术17例（开腹组）。以2010年2月为界，将腹腔镜手术者分为腹腔镜前期组和腹腔镜后期组。比较腹腔镜前期组、腹腔镜后期组与开腹组手术时间、术后进食时间、术后住院天数及并发症情况。结果腹腔镜前期组与开腹组相比，手术时间明显延长（t=3．462，P=0．002），腹腔镜后期组较开腹组手术时间缩短（t=-2．671，P=0．013）。腹腔镜各组较开腹组术后肠蠕动恢复快，进食时间早，且以腹腔镜后期组为著（Z=-3．819，P：0．000）。腹腔镜各组较开腹组术后住院时间明显缩短，以腹腔镜后期组为著（Z=-3．661，P=0．000）。腹腔镜组术后5例近期肠炎，1例皮下气肿。开腹组2例切口感染、1例切口裂开、2例近期肠炎。两组并发症的发生率比较，差异无统计学意义（x^2=1．362，P=0．286）。结论婴儿腹腔镜下结肠次全切除术是治疗长段型HD、HAD及HD合并HAD的微创方法，该方法创伤小，住院时间短，疗效好，安全可靠，值得推广。

The clinical analysis of laparoscopic-assisted subtotal colectomy in infants

Objetive To detect the feasibility of laparoscopie-assisted subtotal colectomy m mlants. Method A total of 55 infants with long-segment Hirschsprung＇ s disease（HD） or Hirschsprung＇ s disease of allied disorder （HAD） underwent laparoscopic-assisted subtotal colectomy from March 2006 to March 2012 were reviewed,. All the patients were divided into laparoscopic surgery group （38 infants ） and open surgery group （17 infants）. The laparoscopic surgery group were divided into two groups： the earlier period group （ Group 1 ）, which didn＇ t used ligasure for blood vessel closure during the laparoscopic approaches, and the later period group （ Group 2） ＂, which uesd ligasure. The operative time, postoperative oral intake, the letigth of postoperative hospital stay and complications in each group of laparoscopic approaches were compared with open approaches retrospectively. Result In Group 1 the mean operating time was longer for the open group （t = 3.462, P 〈 0.05 ）. But the mean operating time was shorter in Group 2 than the open group （ t = - 2. 671, P 〈 0. 05）. The oral intake started earlier in the laparoscopic group, especially in Group 2 （ Z = - 3. 819, P 〈 0. 05 ）. The length of postoperative stay was shorter for the laparoscopic group, especially for Group 2 （ Z = - 3. 661 ,P 〈 0. 05 ）. Six complication was presented in the laparoscopic procedure and four in the open ap- proach. No significant difference was found in the complications occurred in the laparoscopic group and the open approach （X2 = 1. 362 ,P = 0. 286）. Conclusions Laparoscopic-assisted subtotal colectomy is safe and effective surgical methods for long-segment HD or HAD.