腹腔镜辅助Soave手术与开腹手术治疗小儿结肠冗长症的对比研究

目的:探讨腹腔镜辅助Soave手术与开腹手术治疗小儿结肠冗长症的手术效果、安全性及并发症。方法:2010~2013年收治小儿结肠冗长症患者64例,年龄2~116个月,体重3.9~21.5 kg,均以反复顽固性便秘为主要临床表现,钡剂灌肠检查患儿有结肠冗长表现。行腹腔镜辅助Soave术41例,开腹手术23例。结果:腹腔镜组手术时间平均(70.95±6.66)min,术中出血量平均(4.07±1.17)ml,术后平均住院(5.85±1.01)d,无一例发生切口感染、术后血尿。腹腔镜组手术时间、术中出血量、术后住院时间、切口感染、术后血尿等均明显优于开腹手术组,差异有统计学意义(P<0.05)。术后并发症小肠结肠炎、肛周皮炎、污粪等两组差异无统计学意义。结论:腹腔镜辅助Soave术治疗小儿结肠冗长症具有安全、有效、手术时间短、患儿创伤小、出血少、操作简单、并发症少、美观等优点,可达到治愈便秘的目的,与开腹手术相比,具有明显优势。腹腔镜辅助Soave术可作为手术治疗小儿结肠冗长症的首选术式。

Comparison of therapeutic effect between laparoscopic-assisted Soave operation with laparotomy in the treatment of pediatric dolichocolon

Objective：This study was aimed to compare the difference of the clinical therapeutic effect,security and complica-tions of laparoscopic-assisted Soave operation with open operation in the treatment of pediatric dolichocolon. Methods ： The retrospective analysis was made on the clinical data of 64 children who suffered from dolichocolon and underwent laparoscopic-assisted Soave opera-tion or open operation from 2010 to 2013. Their ages ranged from 2 to 116 months and they weighed 3.9 to 21.5 kg with repeated in-tractable constipation as the main clinical manifestations. Barium enema examination revealed redundant colon. 41 cases underwent lapa-roscopic-assisted Soave operation and 23 cases underwent open operation. Results ：The procedure was successful in all the 64 cases. In laparoscopic-assisted Soave group the operation time was （70.95 ± 6.66 ） rain. Intraoperative blood loss was （4.07 ± 1.17 ） ml. The average hospital stay after surgery was （5.85 ± 1.01 ） d. Incision infection and postoperative hematuria were not found. Laparoscopic operation time,intraoperative bleeding, postoperative hospital stay, incision infection, postoperative hematuria were significantly better than the open operation group, the differences were statistically significant （ P 〈 0.05 ）. There was no significant difference in the post- operative complications such as enterocolitis, perianal dermatitis and fecal contamination between the 2 groups. Conclusions：Compared with open operation, laparoscopic assisted Soave operation in treating infantile redundant colon is safe, effective, easy, mini-invasive, has obvious advantages of shorter operative time, less blood loss, fewer complications, better cosmetic results. It could cure the constipation, and can be the first choice to treat pediatric dolichocolon.