小婴儿腹腔镜和剖腹巨结肠根治术的临床研究

目的 比较腹腔镜和剖腹行巨结肠根治术后二组婴儿在临床各方面的特点。方法 随机地选取同期手术的腹腔镜辅助下巨结肠根治术和传统剖腹手术巨结肠根治术婴儿各15例，年龄25～152d，其中长段型14例，普通型14例，短段型2例。分别于手术前后测定免疫功能，观察术后肠功能恢复情况，术后随访情况逐一比较。结果 术后肠功能恢复腹腔镜组较手术组早2～3d。手术组术后CD3、CD4较术前明显下降，CD4／CD8比值较术前降低，补体C3值显著升高。腹腔镜组CD3、CD4及G补体均较术前无明显变化。术后随访两组患儿排便功能无明显的差异，但腹腔镜组腹部瘢痕明显美观。结论 腹腔镜巨结肠根治术对患儿免疫干扰小，肠功能恢复早，美观，远期排便功能两组无差异。

Comparison of laparoscopy-assisted pull-through and open operation for Hirschsprung's disease in infants

Objective To compare the clinical outcomes of laparoscopy assisted pull through and open operation for Hirschsprung,s Disease(HD) in infants.Methods 30 infants (age: 25 to 152 days) with HD were randomize into open operation group (OP, n =15) and laparoscopy group (LP, n =15). There were 14 long segment, 14 common type and 2 short segment HD cases. The immunological indexes, intestinal function and long term outcomes were compared.Results In the OP group, the postoperative levels of CD3,CD4,CD4:CD8 were significantly lower and complement C3 was higher than preoperative period. In the LP group, there was no significant change in CD3,CD4,C3 levels post operatively. The LP group intestinal functional recovery was 2 3 days faster than OP group. Long term follow up study showed that there was no significant difference in bowel function between the two groups.Conclusions Laparoscopic endoretal pull through procedure is feasible in infants with Hirschsprung,s disease. It reduces the immune reaction and shortens recovery time with comparable long term bowel function.