腹腔镜手术治疗新生儿先天性巨结肠的疗效观察

目的:对比腹腔镜辅助Soave术与传统经腹Soave术治疗新生儿先天性巨结肠的临床疗效。方法:回顾分析2005年6月至2011年3月经临床症状、钡剂灌肠、术后病理证实为先天性巨结肠127例患儿的临床资料,其中78例行腹腔镜Soave术(A组),49例行传统经腹Soave术(B组)。结果:A组中1例因腹腔粘连严重中转开腹,余均顺利完成腹腔镜手术;术中出血量平均(10.2±2.6)ml,术后平均住院(8.2±1.4)d,术后发生便秘1例、大便失禁1例、先天性巨结肠相关性肠炎2例(Hirschsprung associated enterocolitis,HAEC)、肠梗阻1例,无切口感染及肛门狭窄。B组术中出血量平均(15.1±3.4)ml,术后平均住院(12.8±2.7)d,术后发生便秘3例、肛门狭窄2例、大便失禁2例、HAEC 5例、切口感染2例、肠梗阻4例。结论:腹腔镜辅助Soave术具有患儿创伤小、康复快、术后进食早、输液时间及住院时间短、术后并发症少等优点,手术安全可靠,与传统开腹手术相比,具有一定优越性,适于新生儿。

Observation on the clinical efficacy of laparoscopic treatment for neonatal congenital Hirschsprung disease

Objective： To compare the therapeutic effect of laparoscopic-assisted Soave surgery and traditional transabdominal Soave for neonatal congenital Hirschsprung disease.Methods： Retrospective analysis was made on the clinical data of 127 hospitalized children diagnosed as congenital Hirschsprung disease according to clinical symptoms,barium enema and postoperative pathology from Jun.2005 to Mar.2011.78 cases（group A） with congenital Hirschsprung disease underwent laparoscopic Soave surgery,49 cases（group B） were operated by traditional transabdominal Soave.Results： All patients were followed up for two to three years.1 case of group A was converted to open surgery for serious abdominal adhesions,laparoscopic surgery of the remaining children were successfully completed.The average amount of bleeding was（10.2 ± 2.6） ml and postoperative hospital stay was（8.2 ± 1.4） d in group A.And there were 1 case of constipation,1 fecal incontinence,2 cases of Hirschsprung associated enterocolitis（HAEC）,1 intestinal obstruction after operations.No wound mfection or anal stenosis was found.The average amount of bleeding was（15.1 ± 3.4） ml and postoperative hospital stay was（12.8 ± 2.7） d in group B.And there were 3 cases of constipation,2 cases of anal stenosis,2 cases of fecal incontinence,5 HAEC,2 wound infection and 4 cases of intestinal obstruction after operations in group B.Conclusions： Laparoscopic-assisted Soave surgery is safe,reliable and suitable for newborns for little trauma,quick recovery,postoperative early eating,short infusion time,use of antibiotics and hospitalization time,little postoperative complications and is superior to traditional transabdominal Soave surgery.